Breast and ovarian cancer methylation markers and uses thereof

ABSTRACT

Disclosed herein are methods and kits for identifying a subject as having breast cancer. Also provided herein are methods and kits for determining the prognosis of a subject having breast cancer and for determining the progression of breast cancer in a subject.

CROSS-REFERENCE

This application claims the benefit of U.S. Provisional Application No.62/358,771, filed Jul. 6, 2016, which application is incorporated hereinby reference.

BACKGROUND OF THE DISCLOSURE

Cancer is a leading cause of deaths worldwide, with annual casesexpected to increase from 14 million in 2012 to 22 million during thenext two decades (WHO). Diagnostic procedures for breast cancer orovarian cancer, in some cases, begin only after a patient is alreadypresent with symptoms, leading to costly, invasive, and sometimestime-consuming procedures. In addition, inaccessible areas sometimesprevent an accurate diagnosis. Further, high cancer morbidities andmortalities are associated with late diagnosis.

SUMMARY OF THE DISCLOSURE

Provided herein are methods and kits for identifying a subject as havingbreast cancer or ovarian cancer. Also provided herein are methods andkits for determining the prognosis of a subject having breast cancer orovarian cancer. Further provided herein are methods and kits fordetermining the progression of breast cancer or ovarian cancer in asubject.

In certain embodiments, provided herein is a method of selecting asubject suspected of having breast cancer for treatment, the methodcomprising: (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject suspected of having breast cancer;(b) generating a methylation profile comprising one or more biomarkersselected from: cg01327147, cg02680086, cg04772948, cg04917276,cg05395187, cg07493516, cg08268679, cg08549335, cg09819083, cg13976210,cg14817783, cg15412918, cg18482112, cg20069090, cg24732563, cg00886954,cg23690893, and cg10673833 from the extracted genomic DNA; (c) comparingthe methylation profile of the one or more biomarkers with a control;(d) identifying the subject as having breast cancer if the methylationprofile correlates to the control; and (e) administering an effectiveamount of a therapeutic agent to the subject if the subject isidentified as having breast cancer.

In some embodiments, the methylation profile comprises cg10673833.

In some embodiments, the methylation profile comprises one or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893.

In some embodiments, the methylation profile comprises cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, and cg23690893.

In some embodiments, the comparing further comprises generating apair-wise methylation difference dataset comprising: (i) a firstdifference between the methylation profile of the treated genomic DNAwith a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

In some embodiments, the comparing further comprises analyzing thepair-wise methylation difference dataset with a control by a machinelearning method to generate the methylation profile.

In some embodiments, the first primary cancer sample is a breast cancersample.

In some embodiments, the second primary cancer sample is a non-breastcancer sample.

In some embodiments, the control comprises a set of methylationprofiles, wherein each said methylation profile is generated from abiological sample obtained from a known cancer type.

In some embodiments, the known cancer type is breast cancer. In someembodiments, the known cancer type is a relapsed or refractory breastcancer. In some embodiments, the known cancer type is a metastaticbreast cancer.

In some embodiments, the machine learning method utilizes an algorithmselected from one or more of the following: a principal componentanalysis, a logistic regression analysis, a nearest neighbor analysis, asupport vector machine, and a neural network model.

In some embodiments, the generating further comprises hybridizing eachof the one or more biomarkers with a probe, and performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers.

In some embodiments, the biological sample comprises a blood sample. Insome embodiments, the biological sample comprises a tissue biopsysample. In some embodiments, the biological sample comprises circulatingtumor cells.

In some embodiments, the subject is a human.

In certain embodiments, provided herein is a method of generating amethylation profile of a biomarker in a subject in need thereof,comprising: (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject; (b) detecting a hybridizationbetween the extracted genomic DNA and a probe, wherein the probehybridizes to a biomarker selected from cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833; and (c) generating amethylation profile based on the detected hybridization between theextracted genomic DNA and the probe.

In some embodiments, the methylation profile comprises cg10673833.

In some embodiments, the methylation profile comprises one or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893.

In some embodiments, the methylation profile comprises cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, and cg23690893.

In some embodiments, the generating further comprises generating apair-wise methylation difference dataset comprising: (i) a firstdifference between the methylation profile of the treated genomic DNAwith a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

In some embodiments, the generating further comprises analyzing thepair-wise methylation difference dataset with a control by a machinelearning method to generate the methylation profile.

In some embodiments, the first primary cancer sample is a breast cancersample.

In some embodiments, the second primary cancer sample is a non-breastcancer sample.

In some embodiments, the control comprises a set of methylationprofiles, wherein each said methylation profile is generated from abiological sample obtained from a known cancer type.

In some embodiments, the known cancer type is breast cancer. In someembodiments, the known cancer type is a relapsed or refractory breastcancer. In some embodiments, the known cancer type is a metastaticbreast cancer. In some embodiments, the known cancer type is ductalcarcinoma in situ, invasive or infiltrating ductal carcinoma, invasiveor infiltrating lobular carcinoma, lobular carcinoma in situ,inflammatory breast cancer, Paget disease of the nipple, Phyllodestumor, angiosarcoma, metaplastic carcinoma, low-grade adenosquamouscarcinoma, spindle cell carcinoma of the breast, squamous carcinoma,triple-negative breast cancer, or mixed carcinoma. In some embodiments,invasive ductal carcinoma comprises tubular carcinoma of the breast,medullary carcinoma of the breast, mucinous (or colloid) carcinoma ofthe breast, papillary carcinoma of the breast, micropapillary carcinoma,or cribriform carcinoma of the breast.

In some embodiments, the machine learning method utilizes an algorithmselected from one or more of the following: a principal componentanalysis, a logistic regression analysis, a nearest neighbor analysis, asupport vector machine, and a neural network model.

In some embodiments, the method further comprises performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers prior to generating the methylation profile.

In some embodiments, the biological sample comprises a blood sample. Insome embodiments, the biological sample comprises a tissue biopsysample. In some embodiments, the biological sample comprises circulatingtumor cells.

In some embodiments, the subject is a human.

In certain embodiments, provided herein is a method of determining theprognosis of a subject having breast cancer or monitoring theprogression of breast cancer in the subject, comprising: (a) processingan extracted genomic DNA with a deaminating agent to generate a genomicDNA sample comprising deaminated nucleotides, wherein the extractedgenomic DNA is obtained from a biological sample from the subject havingbreast cancer; (b) generating a methylation profile comprising one ormore biomarkers selected from: cg00819310, cg04447890, cg08623383,cg09799714, cg10971790, cg15357639, cg17188046, cg21230435, cg22043361,and cg24229963 from the extracted genomic DNA; (c) obtaining amethylation score based on the methylation profile of the one or morebiomarkers; and (d) based on the methylation score, initiate a firsttreatment, decrease a dosage of a first therapeutic agent if the subjecthas experienced a remission, initiate a second treatment if the subjecthas experienced a relapse, or switch to a second therapeutic agent ifthe subject becomes refractory to the first therapeutic agent.

In some embodiments, the methylation profile comprises cg00819310,cg04447890, cg08623383, cg09799714, cg10971790, cg15357639, cg17188046,cg21230435, cg22043361, and cg24229963.

In some embodiments, the methylation profile further comprises one ormore biomarkers selected from: cg24714666, cg03156547, cg06605933,cg09601629, cg13278334, cg23653712, cg11851098, cg12188860, cg25189085and cg25488021. In some embodiments, the methylation profile furthercomprises one or more biomarkers selected from: cg24714666, cg03156547,cg06605933, cg09601629, cg13278334, cg11851098, cg12188860, cg25189085,and cg25488021.

In some embodiments, the methylation profile further comprisescg24714666.

In some embodiments, the methylation profile further comprises one ormore biomarkers selected from: cg03156547, cg06605933, cg09601629,cg13278334, cg11851098, cg12188860, cg25189085, and cg25488021.

In some embodiments, the methylation profile further comprisescg24714666, cg03156547, cg06605933, cg09601629, cg13278334, cg11851098,cg12188860, cg25189085, and cg25488021.

In some embodiments, the methylation score of from about 1.5 to about 3is indicative of a survival for at least 6 months. In some embodiments,the methylation score of from about 1.5 to about 3 is indicative of asurvival for at least 1 year. In some embodiments, the methylation scoreof from about 1.5 to about 3 is indicative of a survival for at least1.5 years. In some embodiments, the methylation score of from about 1.5to about 3 is indicative of a survival for at least 2 years. In someembodiments, the methylation score of from about 1.5 to about 3 isindicative of a survival for at least 2.5 years. In some embodiments,the methylation score of from about 1.5 to about 3 is indicative of asurvival for at least 3 years. In some embodiments, the methylationscore of from about 1.5 to about 3 is indicative of a survival for atleast 4 years. In some embodiments, the methylation score of from about1.5 to about 3 is indicative of a survival for at least 5 years.

In some embodiments, the methylation score of from about 1.5 to about2.5 is indicative of a survival for at least 6 months. In someembodiments, the methylation score of from about 1.5 to about 2.5 isindicative of a survival for at least 1 year. In some embodiments, themethylation score of from about 1.5 to about 2.5 is indicative of asurvival for at least 1.5 years. In some embodiments, the methylationscore of from about 1.5 to about 2.5 is indicative of a survival for atleast 2 years. In some embodiments, the methylation score of from about1.5 to about 2.5 is indicative of a survival for at least 2.5 years. Insome embodiments, the methylation score of from about 1.5 to about 2.5is indicative of a survival for at least 3 years. In some embodiments,the methylation score of from about 1.5 to about 2.5 is indicative of asurvival for at least 4 years. In some embodiments, the methylationscore of from about 1.5 to about 2.5 is indicative of a survival for atleast 5 years.

In some embodiments, the methylation score of less than 1.5 isindicative of a survival of less than 5 years. In some embodiments, themethylation score of less than 1.5 is indicative of a survival of lessthan 4 years. In some embodiments, the methylation score of less than1.5 is indicative of a survival of less than 3 years. In someembodiments, the methylation score of less than 1.5 is indicative of asurvival of less than 2.5 years. In some embodiments, the methylationscore of less than 1.5 is indicative of a survival of less than 2 years.In some embodiments, the methylation score of less than 1.5 isindicative of a survival of less than 1.5 years. In some embodiments,the methylation score of less than 1.5 is indicative of a survival ofless than 1 year. In some embodiments, the methylation score of lessthan 1.5 is indicative of a survival of less than 6 months.

In some embodiments, the methylation score is calculated based on Coxproportional hazards (PH) regression analysis.

In some embodiments, breast cancer is metastatic breast cancer.

In some embodiments, breast cancer is ductal carcinoma in situ, invasiveor infiltrating ductal carcinoma, invasive or infiltrating lobularcarcinoma, lobular carcinoma in situ, inflammatory breast cancer, Pagetdisease of the nipple, Phyllodes tumor, angiosarcoma, metaplasticcarcinoma, low-grade adenosquamous carcinoma, spindle cell carcinoma ofthe breast, squamous carcinoma, triple-negative breast cancer, or mixedcarcinoma. In some embodiments, invasive ductal carcinoma comprisestubular carcinoma of the breast, medullary carcinoma of the breast,mucinous (or colloid) carcinoma of the breast, papillary carcinoma ofthe breast, micropapillary carcinoma, or cribriform carcinoma of thebreast.

In some embodiments, the generating further comprises hybridizing eachof the one or more biomarkers with a probe, and performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers.

In some embodiments, the biological sample comprises a blood sample. Insome embodiments, the biological sample comprises a tissue biopsysample. In some embodiments, the biological sample comprises circulatingtumor cells.

In some embodiments, the subject is a human.

In certain embodiments, provided herein is a method of selecting asubject suspected of having ovarian cancer for treatment, the methodcomprising: (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject suspected of having ovarian cancer;(b) generating a methylation profile comprising biomarker cg10673833from the extracted genomic DNA; (c) comparing the methylation profile ofthe biomarkers with a control; (d) identifying the subject as havingovarian cancer if the methylation profile correlates to the control; and(e) administering an effective amount of a therapeutic agent to thesubject if the subject is identified as having ovarian cancer.

In some embodiments, the comparing further comprises generating apair-wise methylation difference dataset comprising: (i) a firstdifference between the methylation profile of the treated genomic DNAwith a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

In some embodiments, the comparing further comprises analyzing thepair-wise methylation difference dataset with a control by a machinelearning method to generate the methylation profile.

In some embodiments, the first primary cancer sample is an ovariancancer sample.

In some embodiments, the second primary cancer sample is a non-ovariancancer sample.

In some embodiments, the control comprises a set of methylationprofiles, wherein each said methylation profile is generated from abiological sample obtained from a known cancer type.

In some embodiments, the known cancer type is ovarian cancer. In someembodiments, the known cancer type is a relapsed or refractory ovariancancer. In some embodiments, the known cancer type is a metastaticovarian cancer.

In some embodiments, the machine learning method utilizes an algorithmselected from one or more of the following: a principal componentanalysis, a logistic regression analysis, a nearest neighbor analysis, asupport vector machine, and a neural network model.

In some embodiments, the generating further comprises hybridizing eachof the one or more biomarkers with a probe, and performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers.

In some embodiments, the biological sample comprises a blood sample. Insome embodiments, the biological sample comprises a tissue biopsysample. In some embodiments, the biological sample comprises circulatingtumor cells.

In some embodiments, the subject is a human.

In certain embodiments, provided herein is a method of generating amethylation profile of a biomarker in a subject in need thereof,comprising: (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject; (b) detecting a hybridizationbetween the extracted genomic DNA and a probe, wherein the probehybridizes to biomarker cg10673833; and (c) generating a methylationprofile based on the detected hybridization between the extractedgenomic DNA and the probe.

In some embodiments, the generating further comprises generating apair-wise methylation difference dataset comprising: (i) a firstdifference between the methylation profile of the treated genomic DNAwith a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

In some embodiments, the generating further comprises analyzing thepair-wise methylation difference dataset with a control by a machinelearning method to generate the methylation profile.

In some embodiments, the first primary cancer sample is an ovariancancer sample.

In some embodiments, the second primary cancer sample is a non-ovariancancer sample.

In some embodiments, the control comprises a set of methylationprofiles, wherein each said methylation profile is generated from abiological sample obtained from a known cancer type.

In some embodiments, the known cancer type is ovarian cancer. In someembodiments, the known cancer type is a relapsed or refractory ovariancancer. In some embodiments, the known cancer type is a metastaticovarian cancer. In some embodiments, the known cancer type is epithelialovarian cancer, stromal cell ovarian tumors, germ cell ovarian tumors,borderline ovarian tumors, small cell ovarian carcinoma, neuro-endocrinecarcinomas, squamous cell carcinoma, struma ovarii malignum orpsammocarcinoma.

In some embodiments, the machine learning method utilizes an algorithmselected from one or more of the following: a principal componentanalysis, a logistic regression analysis, a nearest neighbor analysis, asupport vector machine, and a neural network model.

In some embodiments, the method further comprises performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers prior to generating the methylation profile.

In some embodiments, the biological sample comprises a blood sample. Insome embodiments, the biological sample comprises a tissue biopsysample. In some embodiments, the biological sample comprises circulatingtumor cells.

In some embodiments, the subject is a human.

In certain embodiments, provided herein is a kit comprising a set ofnucleic acid probes that hybridizes to biomarkers: cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, cg23690893, and cg10673833. In someembodiments, the set of nucleic acid probes comprises a set of padlockprobes.

In certain embodiments, provided herein is kit comprising a set ofnucleic acid probes that hybridizes to biomarkers: cg00819310,cg04447890, cg08623383, cg09799714, cg10971790, cg15357639, cg17188046,cg21230435, cg22043361, and cg24229963. In some embodiments, the kitfurther comprises a nucleic acid probe that hybridizes to a biomarkerselected from cg24714666, cg03156547, cg06605933, cg09601629,cg13278334, cg11851098, cg12188860, cg25189085, and cg25488021. In someembodiments, the set of nucleic acid probes comprises a set of padlockprobes.

In certain embodiments, provided herein is kit comprising a nucleic acidprobe that hybridizes to biomarker cg10673833. In some embodiments, thenucleic acid probe comprises a padlock probe.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of the disclosure are set forth with particularity inthe appended claims. A better understanding of the features andadvantages of the present disclosure will be obtained by reference tothe following detailed description that sets forth illustrativeembodiments, in which the principles of the disclosure are utilized, andthe accompanying drawings of which:

FIG. 1 illustrates Kaplan-Meier curves from LASSO (left panel) andBosting (right panel).

FIG. 2 shows Cox proportional hazards regression prediction curves fromLASSO (left panel) and Boosting (right panel).

FIG. 3 shows a multiclass ROC curve from LASSO.

FIG. 4A-FIG. 4B show the distribution of Cob-2 methylation rate ofcell-free DNA (cfDNA) in normal and breast cancer plasma.

FIG. 5A-FIG. 5B illustrate the methylation rate of Cob-2 of cell-freeDNA (cfDNA) in normal and breast cancer plasma.

FIG. 6A-FIG. 6B illustrate the methylation rate of cell-free DNA (cfDNA)in different subgroup of breast cancer plasma.

FIG. 7 illustrates the ROC curve of Cob-2 methylateion rate of cell-freeDNA (cfDNA).

FIG. 8A-FIG. 8B show the Cob-2 methylation rate of cell-free DNA (cfDNA)from individual breast cancer patients with partial response (PR) to atherapy.

FIG. 9A-FIG. 9B show the Cob-2 methylation rate of cell-free DNA (cfDNA)from individual breast cancer patients with stable disease (SD).

FIG. 10A-FIG. 10B show the Cob-2 methylation rate of cell-free DNA(cfDNA) from individual breast cancer patients with progressive disease(PD).

FIG. 11A-FIG. 11B show the Cob-2 methylation rate of cell-free DNA(cfDNA) from individual breast cancer patients post-surgery.

FIG. 12 shows a boxplot for methylation change in different responsegroups for breast cancer.

FIG. 13 shows a boxplot for methylation change in different responsegroups for breast cancer.

FIG. 14A-FIG. 14B show the methylation rate of cell-free DNA (cfDNA) indifferent subgroup of ovarian cancer plasma.

FIG. 15 illustrates an exemplary BCM for breast cancer.

DETAILED DESCRIPTION OF THE DISCLOSURE

Cancer is characterized by an abnormal growth of a cell caused by one ormore mutations or modifications of a gene leading to dysregulatedbalance of cell proliferation and cell death. DNA methylation silencesexpression of tumor suppression genes, and presents itself as one of thefirst neoplastic changes. Methylation patterns found in neoplastictissue and plasma demonstrate homogeneity, and in some instances areutilized as a sensitive diagnostic marker. For example, cMethDNA assayhas been shown in one study to be about 91% sensitive and about 96%specific when used to diagnose metastatic breast cancer. In anotherstudy, circulating tumor DNA (ctDNA) was about 87.2% sensitive and about99.2% specific when it was used to identify KRAS gene mutation in alarge cohort of patients with metastatic colon cancer (Bettegowda etal., Detection of Circulating Tumor DNA in Early- and Late-Stage HumanMalignancies. Sci. Transl. Med, 6(224):ra24. 2014). The same studyfurther demonstrated that ctDNA is detectable in >75% of patients withadvanced pancreatic, ovarian, colorectal, bladder, gastroesophageal,breast, melanoma, hepatocellular, and head and neck cancers (Bettegowdaet al).

In some embodiments, DNA methylation profiling provides higher clinicalsensitivity and dynamic range compared to somatic mutation analysis forcancer detection. In other instances, altered DNA methylation signaturehas been shown to correlate with the prognosis of treatment response forcertain cancers. For example, one study illustrated that in a group ofpatients with advanced rectal cancer, ten differentially methylatedregions were used to predict patients' prognosis. In addition, SRBC genehypermethylation was associated with poor outcome in patients withcolorectal cancer treated with oxaliplatin in a different study.

In some embodiments, disclosed herein are methods and kits of diagnosingbreast cancer or ovarian cancer based on DNA methylation profiling. Insome instances, provided herein are methods and kits of identifying asubject has having breast cancer or ovarian cancer based on the DNAmethylation profiling. In some instances, also provided herein aremethods and kits of determining the prognosis of a subject having breastcancer or ovarian cancer and determining the progression of breastcancer or ovarian cancer in a subject based on the DNA methylationprofilings.

Methods of Use Methods of Diagnosis of a Subject

Disclosed herein, in certain embodiments, are methods of diagnosingbreast cancer or ovarian cancer and selecting subjects suspected ofhaving breast cancer or ovarian cancer for treatment. In some instances,the methods comprise utilizing one or more biomarkers described herein.In some instances, a biomarker comprises a cytosine methylation site. Insome instances, cytosine methylation comprises 5-methylcytosine (5-mCyt)and 5-hydroxymethylcytosine. In some cases, a cytosine methylation siteoccurs in a CpG dinucleotide motif. In other cases, a cytosinemethylation site occurs in a CHG or CHH motif, in which H is adenine,cytosine, or thymine. In some instances, one or more CpG dinucleotidemotif or CpG site forms a CpG island, a short DNA sequence rich in CpGdinucleotide. In some instances, CpG islands are typically, but notalways, between about 0.2 to about 1 kb in length. In some instances, abiomarker comprises a CpG island.

In some embodiments, disclosed herein is a method of selecting a subjectsuspected of having breast cancer for treatment, in which the methodcomprises (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject suspected of having breast cancer;(b) generating a methylation profile comprising one or more biomarkersselected from: cg01327147, cg02680086, cg04772948, cg04917276,cg05395187, cg07493516, cg08268679, cg08549335, cg09819083, cg13976210,cg14817783, cg15412918, cg18482112, cg20069090, cg24732563, cg00886954,cg23690893, and cg10673833 from the extracted genomic DNA; (c) comparingthe methylation profile of the one or more biomarkers with a control;(d) identifying the subject as having breast cancer if the methylationprofile correlates to the control; and (e) administering an effectiveamount of a therapeutic agent to the subject if the subject isidentified as having breast cancer.

In some embodiments, also disclosed herein is a method of selecting asubject suspected of having ovarian cancer for treatment, the methodcomprising (a) processing an extracted genomic DNA with a deaminatingagent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject suspected of having ovarian cancer;(b) generating a methylation profile comprising biomarker cg10673833from the extracted genomic DNA; (c) comparing the methylation profile ofthe biomarkers with a control; (d) identifying the subject as havingovarian cancer if the methylation profile correlates to the control; and(e) administering an effective amount of a therapeutic agent to thesubject if the subject is identified as having ovarian cancer.

In some embodiments, a methylation profile comprises a plurality of CpGmethylation data for one or more biomarkers described herein. In someinstances, a plurality of CpG methylation data is generated by firstobtaining a genomic DNA (e.g., nuclear DNA or circulating DNA) from abiological sample, and then treating the genomic DNA by a deaminatingagent to generate an extracted genomic DNA. In some instances, theextracted genomic DNA (e.g., extracted nuclear DNA or extractedcirculating DNA) is optionally treated with one or more restrictionenzymes to generate a set of DNA fragments prior to submitting forsequencing analysis to generate CpG methylation data. In some cases, thesequencing analysis comprises hybridizing each of the one or morebiomarkers described herein with a probe, and performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers. In some instances, the CpG methylation data is theninput into a machine learning/classification program to generate amethylation profile.

In some instances, a set of biological samples are generated andsubsequently input into the machine learning/classification program. Insome instances, the set of biological samples comprises 2, 3, 4, 5, 6,7, 8, 9, 10, 20, 30, or more biological samples. In some instances, theset of biological samples comprises 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30,or more normal biological samples. In some instances, the set ofbiological samples comprises 2, 3, 4, 5, 6, 7, 8, 9, 10, 20, 30, or morecancerous biological samples. In some cases, the set of biologicalsamples comprise a biological sample of interest, a first primary cancersample, a second primary cancer sample, a first normal sample, a secondnormal sample, and a third normal sample; wherein the first, and secondprimary cancer samples are different; and wherein the first, second, andthird normal samples are different. In some cases, three pairs ofdifference datasets are generated in which the three pairs of datasetcomprise: a first difference dataset between the methylation profile ofthe biological sample of interest and the first normal sample, in whichthe biological sample of interest and the first normal sample are fromthe same biological sample source; a second difference dataset between amethylation profile of a second normal sample and a methylation profileof a third normal sample, in which the second and third normal samplesare different; and a third difference dataset between a methylationprofile of a first primary cancer sample and a methylation profile of asecond primary cancer sample, in which the first and second primarycancer samples are different. In some instances, the difference datasetsare further input into the machine learning/classification program. Insome cases, a pair-wise methylation difference dataset from the first,second, and third datasets is generated and then analyzed in thepresence of a control dataset or a training dataset by the machinelearning/classification method to generate the cancer CpG methylationprofile. In some instances, the first primary cancer sample is a breastcancer sample. In some cases, the second primary cancer sample is anon-breast cancer sample. In some cases, the machine learning methodcomprises identifying a plurality of markers and a plurality of weightsbased on a top score (e.g., a t-test value, a 0 test value), andclassifying the samples based on the plurality of markers and theplurality of weights. In some cases, the machine learning methodutilizes an algorithm selected from one or more of the following: aprincipal component analysis, a logistic regression analysis, a nearestneighbor analysis, a support vector machine, and a neural network model.

In some embodiments, the CpG methylation profile comprises one or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, cg23690893, and cg10673833. In some embodiments, the CpGmethylation profile comprises two or more biomarkers selected from:cg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, cg23690893, andcg10673833. In some embodiments, the CpG methylation profile comprisesthree or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833. In some embodiments,the CpG methylation profile comprises four or more biomarkers selectedfrom: cg01327147, cg02680086, cg04772948, cg04917276, cg05395187,cg07493516, cg08268679, cg08549335, cg09819083, cg13976210, cg14817783,cg15412918, cg18482112, cg20069090, cg24732563, cg00886954, cg23690893,and cg10673833. In some embodiments, the CpG methylation profilecomprises five or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833. In some embodiments,the CpG methylation profile comprises six or more biomarkers selectedfrom: cg01327147, cg02680086, cg04772948, cg04917276, cg05395187,cg07493516, cg08268679, cg08549335, cg09819083, cg13976210, cg14817783,cg15412918, cg18482112, cg20069090, cg24732563, cg00886954, cg23690893,and cg10673833. In some embodiments, the CpG methylation profilecomprises seven or more biomarkers selected from: cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, cg23690893, and cg10673833. In someembodiments, the CpG methylation profile comprises eight or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, cg23690893, and cg10673833. In some embodiments, the CpGmethylation profile comprises nine or more biomarkers selected from:cg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, cg23690893, andcg10673833. In some embodiments, the CpG methylation profile comprisesten or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833. In some embodiments,the CpG methylation profile comprises eleven or more biomarkers selectedfrom: cg01327147, cg02680086, cg04772948, cg04917276, cg05395187,cg07493516, cg08268679, cg08549335, cg09819083, cg13976210, cg14817783,cg15412918, cg18482112, cg20069090, cg24732563, cg00886954, cg23690893,and cg10673833. In some embodiments, the CpG methylation profilecomprises twelve or more biomarkers selected from: cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, cg23690893, and cg10673833. In someembodiments, the CpG methylation profile comprises cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, cg23690893, and cg10673833.

In some instances, the CpG methylation profile comprises one or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893. In some instances, the CpG methylationprofile comprises two or more biomarkers selected from: cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, and cg23690893. In some instances,the CpG methylation profile comprises three or more biomarkers selectedfrom: cg01327147, cg02680086, cg04772948, cg04917276, cg05395187,cg07493516, cg08268679, cg08549335, cg09819083, cg13976210, cg14817783,cg15412918, cg18482112, cg20069090, cg24732563, cg00886954, andcg23690893. In some instances, the CpG methylation profile comprisesfour or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, and cg23690893. In some instances, the CpGmethylation profile comprises five or more biomarkers selected from:cg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, and cg23690893. In someinstances, the CpG methylation profile comprises six or more biomarkersselected from: cg01327147, cg02680086, cg04772948, cg04917276,cg05395187, cg07493516, cg08268679, cg08549335, cg09819083, cg13976210,cg14817783, cg15412918, cg18482112, cg20069090, cg24732563, cg00886954,and cg23690893. In some instances, the CpG methylation profile comprisesseven or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, and cg23690893. In some instances, the CpGmethylation profile comprises eight or more biomarkers selected from:cg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, and cg23690893. In someinstances, the CpG methylation profile comprises nine or more biomarkersselected from: cg01327147, cg02680086, cg04772948, cg04917276,cg05395187, cg07493516, cg08268679, cg08549335, cg09819083, cg13976210,cg14817783, cg15412918, cg18482112, cg20069090, cg24732563, cg00886954,and cg23690893. In some instances, the CpG methylation profile comprisesten or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, and cg23690893. In some instances, the CpGmethylation profile comprises eleven or more biomarkers selected from:cg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, and cg23690893. In someinstances, the CpG methylation profile comprises twelve or morebiomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893. In some instances, the CpG methylationprofile comprises cg01327147, cg02680086, cg04772948, cg04917276,cg05395187, cg07493516, cg08268679, cg08549335, cg09819083, cg13976210,cg14817783, cg15412918, cg18482112, cg20069090, cg24732563, cg00886954,and cg23690893.

In some instances, the CpG methylation profile comprises biomarkercg10673833.

In some instances, the subject is diagnosed in having breast cancer. Insome instances, breast cancer further comprises a relapsed or refractorybreast cancer. In other instances, breast cancer comprises a metastaticbreast cancer. In some cases, the subject is diagnosed in having arelapsed or refractory breast cancer. In additional cases, the subjectis diagnosed in having a metastatic breast cancer.

In some embodiments, a breast cancer is any type of breast cancer. Insome instances, a breast cancer comprises ductal carcinoma in situ,invasive or infiltrating ductal carcinoma, invasive or infiltratinglobular carcinoma, lobular carcinoma in situ, inflammatory breastcancer, Paget disease of the nipple, Phyllodes tumor, angiosarcoma,metaplastic carcinoma, low-grade adenosquamous carcinoma, spindle cellcarcinoma of the breast, squamous carcinoma, triple-negative breastcancer, or mixed carcinoma. In some cases, invasive ductal carcinomacomprises tubular carcinoma of the breast, medullary carcinoma of thebreast, mucinous (or colloid) carcinoma of the breast, papillarycarcinoma of the breast, micropapillary carcinoma, or cribriformcarcinoma of the breast.

In some cases, breast cancer is further classified by a grade. Forexample, the grades of breast cancer include Grade X, Grade 1, Grade 2,Grade 3 or Grade 4. In some instances, a breast cancer is furtherindicated by a category of tubule formation, nuclear grade and/or themitotic rate. Each category is optionally assigned with a specific scorebetween one and three. In some cases, a stage is assigned based on thetumor, the regional lymph nodes and/or distant metastasis. For example,the stages assigned to the tumor include TX, T0, Tis, T1, T2, T3, or T4.For example, the stages assigned to a regional lymph node include NX,N0, N1, N2, or N3. For example, the stages assigned to a distantmetastasis include MX, M0, or M1. In some cases, the stages includestage 0, stage I, stage II, stage III or stage IV. Sometimes, a breastcancer is classified as more than one grade or stage of cancer.

In some embodiments, the subject diagnosed of having breast cancer isfurther treated with a therapeutic agent. Exemplary therapeutic agentsinclude, but are not limited to, anastrozole, capecitabine,cyclophosphamide, doxorubicin, epirubicin hydrochloride, everolimus,exemestane, fulvestrant, fluorouracil injection, gemcitabinehydrochloride, goserelin acetate, ixabepilone, lapatinib ditosylate,letrozole, methotrexate, paclitaxel, palbociclib, pamidronate disodium,pertuzumab, toremifene, trastuzumab, ado-trastuzumab emtansine, orvinblastine sulfate, or a combination thereof.

In some instances, the subject is diagnosed in having ovarian cancer. Insome instances, ovarian cancer further comprises a relapsed orrefractory ovarian cancer. In other instances, ovarian cancer comprisesa metastatic ovarian cancer. In some cases, the subject is diagnosed inhaving a relapsed or refractory ovarian cancer. In additional cases, thesubject is diagnosed in having a metastatic ovarian cancer.

In some embodiments, an ovarian cancer is any type of ovarian cancer. Insome instances, an ovarian cancer comprises epithelial ovarian cancer,stromal cell ovarian tumors, germ cell ovarian tumors, borderlineovarian tumors, small cell ovarian carcinoma, neuro-endocrinecarcinomas, squamous cell carcinoma, struma ovarii malignum orpsammocarcinoma.

In some embodiments, the subject diagnosed of having ovarian cancer isfurther treated with a therapeutic agent. Exemplary therapeutic agentsinclude, but are not limited, bevacizumab, carboplatin, cisplatin,cyclophosphamide, doxorubicin, gemcitabine hydrochloride, melphalan,topotecan hydrochloride, olaparib, paclitaxel, thiotepa, topotecanhydrochloride, or a combination thereof.

In some embodiments, also described herein include a method ofgenerating a methylation profile of a biomarker. In some instances, themethod comprises (a) processing an extracted genomic DNA with adeaminating agent to generate a genomic DNA sample comprising deaminatednucleotides, wherein the extracted genomic DNA is obtained from abiological sample from the subject; (b) detecting a hybridizationbetween the extracted genomic DNA and a probe, wherein the probehybridizes to a biomarker selected from cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833; and (c) generating amethylation profile based on the detected hybridization between theextracted genomic DNA and the probe.

In some embodiments, one or more biomarkers selected from: cg01327147,cg02680086, cg04772948, cg04917276, cg05395187, cg07493516, cg08268679,cg08549335, cg09819083, cg13976210, cg14817783, cg15412918, cg18482112,cg20069090, cg24732563, cg00886954, cg23690893, and cg10673833 are usedto generate a methylation profile. In some embodiments, two or more,three or more, four or more, five or more, six or more, seven or more,eight or more, nine or more, ten or more, eleven or more, or twelve ormore biomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, cg23690893, and cg10673833 are used to generate themethylation profile. In some embodiments, cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, cg23690893, and cg10673833 are used to generatea methylation profile.

In some embodiments, further described herein include a method ofgenerating a methylation profile of a biomarker which comprises (a)processing an extracted genomic DNA with a deaminating agent to generatea genomic DNA sample comprising deaminated nucleotides, wherein theextracted genomic DNA is obtained from a biological sample from thesubject; (b) detecting a hybridization between the extracted genomic DNAand a probe, wherein the probe hybridizes to biomarker cg10673833; andgenerating a methylation profile based on the detected hybridizationbetween the extracted genomic DNA and the probe.

In some instances, as described elsewhere herein, a pair-wisemethylation difference dataset is generated prior to generating amethylation profile. In some cases, the pair-wise methylation differencedataset comprises (i) a first difference between the methylation profileof the treated genomic DNA with a methylation profile of a first normalsample; (ii) a second difference between a methylation profile of asecond normal sample and a methylation profile of a third normal sample;and (iii) a third difference between a methylation profile of a firstprimary cancer sample and a methylation profile of a second primarycancer sample.

In some cases, the pair-wise methylation difference dataset is analyzedwith a control by a machine learning method to generate a methylationprofile. In some cases, the machine learning method utilizes analgorithm selected from one or more of the following: a principalcomponent analysis, a logistic regression analysis, a nearest neighboranalysis, a support vector machine, and a neural network model.

In some embodiments, a probe comprises a DNA probe, RNA probe, or acombination thereof. In some instances, a probe comprises naturalnucleic acid molecules and non-natural nucleic acid molecules. In somecases, a probe comprises a labeled probe, such as for example,fluorescently labeled probe or radioactively labeled probe. In someinstances, a probe correlates to a CpG site. In some instances, a probeis utilized in a next generation sequencing reaction to generate a CpGmethylation data. In further instances, a probe is used in asolution-based next generation sequencing reaction to generate a CpGmethylation data. In some cases, a probe comprises a molecular beaconprobe, a TaqMan probe, locked nucleic acid probe, a padlock probe, orScorpion probe. In some cases, a probe comprises a pad-lock probe.

In some cases, the method further comprises performing a DNA sequencingreaction such as those described elsewhere herein to quantify themethylation of each of the one or more biomarkers prior to generating amethylation profile.

In some embodiments, a CpG methylation site is located at the promoterregion (e.g., induces a promoter methylation). In some instances,promoter methylation leads to a downregulation of its corresponding geneexpression. In some instances, one or more CpG methylation sitesdescribed supra and in subsequent paragraphs are located at promoterregions, leading to promoter methylation, and subsequent downregulationof the corresponding gene expression. In some instances, the CpGmethylation site is as illustrated in Tables 11 (e.g., Table 11A) or 12.In some cases, an increase in gene expression leads to a decrease intumor volume.

In some embodiments, one or more cg markers reference one or more genes.In some embodiments, cg01327147 references uncharacterized family 31glucosidase KIAA1161 (KIAA1161). In some embodiments, cg02680086references solute carrier family 43 member 1 (SLC43A1). In someembodiments, cg04772948 references uncharacterized LOC284788(LOC284788). In some embodiments, cg04917276 references HNF1 homeobox B(HNF1B). In some embodiments, cg05395187 references nuclear receptorcorepressor 2 (NCOR2). In some embodiments, cg08549335 references zincand ring finger 2, E3 ubiquitin protein ligase (ZNRF2). In someembodiments, cg13976210 references dual specificity phosphatase 12(DUSP12). In some embodiments, cg14817783 references Kelch like familymember 23 (KLHL23). In some embodiments, cg20069090 references RNApolymerase subunit D (POLR1D). In some embodiments, cg00886954references plectin (PLEC1). In some embodiments, cg23690893 referencestrans-2,3-enoyl-CoA reductase (TECR). In some embodiments, cg10673833references myosin IG (MYO1G).

In some embodiments, cg07493516, cg08268679, cg09819083, cg15412918,cg18482112 references, and cg24732563 do not independently reference agene.

In some embodiments, described herein is a method of selecting a subjectsuspected of having breast cancer for treatment, the method comprisinggenerating a methylation profile comprising one or more genes selectedfrom: uncharacterized family 31 glucosidase KIAA1161 (KIAA1161), solutecarrier family 43 member 1 (SLC43A1), uncharacterized LOC284788(LOC284788), HNF1 homeobox B (HNF1B), nuclear receptor corepressor 2(NCOR2), zinc and ring finger 2, E3 ubiquitin protein ligase (ZNRF2),dual specificity phosphatase 12 (DUSP12), Kelch like family member 23(KLHL23), RNA polymerase subunit D (POLR1D), plectin (PLEC1),trans-2,3-enoyl-CoA reductase (TECR), and myosin IG (MYO1G). In someinstances, the methylation profile comprises one or more genes selectedfrom: uncharacterized family 31 glucosidase KIAA1161 (KIAA1161), solutecarrier family 43 member 1 (SLC43A1), uncharacterized LOC284788(LOC284788), HNF1 homeobox B (HNF1B), nuclear receptor corepressor 2(NCOR2), zinc and ring finger 2, E3 ubiquitin protein ligase (ZNRF2),dual specificity phosphatase 12 (DUSP12), Kelch like family member 23(KLHL23), RNA polymerase subunit D (POLR1D), plectin (PLEC1), andtrans-2,3-enoyl-CoA reductase (TECR). In some instances, the methylationprofile comprises: uncharacterized family 31 glucosidase KIAA1161(KIAA1161), solute carrier family 43 member 1 (SLC43A1), uncharacterizedLOC284788 (LOC284788), HNF1 homeobox B (HNF1B), nuclear receptorcorepressor 2 (NCOR2), zinc and ring finger 2, E3 ubiquitin proteinligase (ZNRF2), dual specificity phosphatase 12 (DUSP12), Kelch likefamily member 23 (KLHL23), RNA polymerase subunit D (POLR1D), plectin(PLEC1), and trans-2,3-enoyl-CoA reductase (TECR). In some instances,the methylation profile comprises myosin IG (MYO1G).

In some embodiments, described herein is a method of generating amethylation profile of a gene detecting a hybridization between theextracted genomic DNA and a probe, wherein the probe hybridizes to agene selected from: uncharacterized family 31 glucosidase KIAA1161(KIAA1161), solute carrier family 43 member 1 (SLC43A1), uncharacterizedLOC284788 (LOC284788), HNF1 homeobox B (HNF1B), nuclear receptorcorepressor 2 (NCOR2), zinc and ring finger 2, E3 ubiquitin proteinligase (ZNRF2), dual specificity phosphatase 12 (DUSP12), Kelch likefamily member 23 (KLHL23), RNA polymerase subunit D (POLR1D), plectin(PLEC1), trans-2,3-enoyl-CoA reductase (TECR), and myosin IG (MYO1G). Insome instances, the methylation profile comprises one or more genesselected from: uncharacterized family 31 glucosidase KIAA1161(KIAA1161), solute carrier family 43 member 1 (SLC43A1), uncharacterizedLOC284788 (LOC284788), HNF1 homeobox B (HNF1B), nuclear receptorcorepressor 2 (NCOR2), Kelch like family member 23 (KLHL23), zinc andring finger 2, E3 ubiquitin protein ligase (ZNRF2), dual specificityphosphatase 12 (DUSP12), RNA polymerase subunit D (POLR1D), plectin(PLEC1), and trans-2,3-enoyl-CoA reductase (TECR). In some instances,the methylation profile comprises: uncharacterized family 31 glucosidaseKIAA1161 (KIAA1161), solute carrier family 43 member 1 (SLC43A1),uncharacterized LOC284788 (LOC284788), HNF1 homeobox B (HNF1B), nuclearreceptor corepressor 2 (NCOR2), zinc and ring finger 2, E3 ubiquitinprotein ligase (ZNRF2), Kelch like family member 23 (KLHL23), dualspecificity phosphatase 12 (DUSP12), RNA polymerase subunit D (POLR1D),plectin (PLEC1), and trans-2,3-enoyl-CoA reductase (TECR). In someinstances, the methylation profile comprises myosin IG (MYO1G).

In some embodiments, cg marker cg10673833.1 references myosin IG(MYO1G). In some embodiments, described herein is a method of selectinga subject suspected of having ovarian cancer for treatment, the methodcomprising generating a methylation profile comprising gene myosin IG(MYO1G).

Determining the Prognosis of a Subject Having Breast Cancer orMonitoring the Progression of Breast Cancer in a Subject

In some embodiments, disclosed herein include a method of determiningthe prognosis of a subject having breast cancer or monitoring theprogression of breast cancer in a subject.

In some embodiments, disclosed herein include a method of determiningthe prognosis of a subject having breast cancer and/or monitoring theprogression of breast cancer in a subject. In some instances, breastcancer comprises ductal carcinoma in situ, invasive or infiltratingductal carcinoma, invasive or infiltrating lobular carcinoma, lobularcarcinoma in situ, inflammatory breast cancer, Paget disease of thenipple, Phyllodes tumor, angiosarcoma, metaplastic carcinoma, low-gradeadenosquamous carcinoma, spindle cell carcinoma of the breast, squamouscarcinoma, triple-negative breast cancer, or mixed carcinoma. In someinstances, invasive ductal carcinoma comprises tubular carcinoma of thebreast, medullary carcinoma of the breast, mucinous (or colloid)carcinoma of the breast, papillary carcinoma of the breast,micropapillary carcinoma, or cribriform carcinoma of the breast. In someinstances, disclosed herein is a method of determining the prognosis ofa subject having breast cancer or monitoring the progression of breastcancer in a subject. In some embodiments, the method comprises (a)processing an extracted genomic DNA with a deaminating agent to generatea genomic DNA sample comprising deaminated nucleotides, wherein theextracted genomic DNA is obtained from a biological sample from thesubject having breast cancer; (b) generating a methylation profilecomprising one or more biomarkers selected from: cg00819310, cg04447890,cg08623383, cg09799714, cg10971790, cg15357639, cg17188046, cg21230435,cg22043361, and cg24229963 from the extracted genomic DNA; (c) obtaininga methylation score based on the methylation profile of the one or morebiomarkers; and (d) based on the methylation score, initiate a firsttreatment, decrease a dosage of a first therapeutic agent if the subjecthas experienced a remission, initiate a second treatment if the subjecthas experienced a relapse, or switch to a second therapeutic agent ifthe subject becomes refractory to the first therapeutic agent.

In some instances, the methylation profile comprises two or morebiomarkers selected from: cg00819310, cg04447890, cg08623383,cg09799714, cg10971790, cg15357639, cg17188046, cg21230435, cg22043361,and cg24229963. In some instances, the methylation profile comprisesthree or more biomarkers selected from: cg00819310, cg04447890,cg08623383, cg09799714, cg10971790, cg15357639, cg17188046, cg21230435,cg22043361, and cg24229963. In some instances, the methylation profilecomprises four or more biomarkers selected from: cg00819310, cg04447890,cg08623383, cg09799714, cg10971790, cg15357639, cg17188046, cg21230435,cg22043361, and cg24229963. In some instances, the methylation profilecomprises five or more biomarkers selected from: cg00819310, cg04447890,cg08623383, cg09799714, cg10971790, cg15357639, cg17188046, cg21230435,cg22043361, and cg24229963. In some instances, the methylation profilecomprises six or more biomarkers selected from: cg00819310, cg04447890,cg08623383, cg09799714, cg10971790, cg15357639, cg17188046, cg21230435,cg22043361, and cg24229963. In some instances, the methylation profilecomprises seven or more biomarkers selected from: cg00819310,cg04447890, cg08623383, cg09799714, cg10971790, cg15357639, cg17188046,cg21230435, cg22043361, and cg24229963. In some instances, themethylation profile comprises eight or more biomarkers selected from:cg00819310, cg04447890, cg08623383, cg09799714, cg10971790, cg15357639,cg17188046, cg21230435, cg22043361, and cg24229963. In some instances,the methylation profile comprises nine or more biomarkers selected from:cg00819310, cg04447890, cg08623383, cg09799714, cg10971790, cg15357639,cg17188046, cg21230435, cg22043361, and cg24229963. In some instances,the methylation profile comprises cg00819310, cg04447890, cg08623383,cg09799714, cg10971790, cg15357639, cg17188046, cg21230435, cg22043361,and cg24229963.

In some cases, the methylation profile further comprises one or morebiomarkers selected from: cg24714666, cg03156547, cg06605933,cg09601629, cg13278334, cg23653712, cg11851098, cg12188860, cg25189085,and cg25488021. In some cases, the methylation profile further comprisesone or more biomarkers selected from: cg24714666, cg03156547,cg06605933, cg09601629, cg13278334, cg11851098, cg12188860, cg25189085,and cg25488021. In some cases, the methylation profile further comprisesone or more, two or more, three or more, four or more, five or more, sixor more, seven or more, eight or more, or nine or more biomarkersselected from: cg24714666, cg03156547, cg06605933, cg09601629,cg13278334, cg11851098, cg12188860, cg25189085, and cg25488021. In somecases, the methylation profile further comprises biomarkers cg24714666,cg03156547, cg06605933, cg09601629, cg13278334, cg11851098, cg12188860,cg25189085, and cg25488021.

In some cases, the methylation profile further comprises one or morebiomarkers selected from: cg03156547, cg06605933, cg09601629,cg13278334, cg11851098, cg12188860, cg25189085, and cg25488021. In somecases, the methylation profile further comprises one or more, two ormore, three or more, four or more, five or more, six or more, seven ormore, or eight or more biomarkers selected from: cg03156547, cg06605933,cg09601629, cg13278334, cg11851098, cg12188860, cg25189085, andcg25488021. In some cases, the methylation profile further comprisesbiomarkers cg03156547, cg06605933, cg09601629, cg13278334, cg11851098,cg12188860, cg25189085, and cg25488021.

In some cases, the methylation profile further comprises cg24714666.

In some instances, the methylation profile comprises one or morebiomarkers selected from: cg00819310, cg04447890, cg08623383,cg09799714, cg10971790, cg15357639, cg17188046, cg21230435, cg22043361and cg24229963; and one or more biomarkers selected from: cg24714666,cg03156547, cg06605933, cg09601629, cg13278334, cg11851098, cg12188860,cg25189085, and cg25488021.

In some embodiments, one or more cg markers reference one or more genes.In some embodiments, cg00819310 references VANGL planar cell polarityprotein 1 (VANGL1). In some embodiments, cg04447890 references Gprotein-coupled receptor 177 (GPR177). In some embodiments, cg08623383references chromosome 1 open reading frame 38 (Clorf38). In someembodiments, cg09799714 references PDZ domain containing 3 (PDZD3). Insome embodiments, cg10971790 references fuzzy planar cell polarityprotein (FUZ). In some embodiments, cg15357639 references 8-oxoguanineDNA glycosylase (OGG1). In some embodiments, cg17188046 references Tbachyury transcription factor (T). In some embodiments, cg21230435references opsin 1 (cone pigments), short-wave-sensitive (OPN1SW). Insome embodiments, cg22043361 references zinc finger and BTB domaincontaining 25 (ZBTB25). In some embodiments, cg24229963 references zincfinger AN1-type containing 1 (ZFAND1).

In further embodiments, one or more cg markers reference one or moregenes. In further embodiments, cg03156547 references cadherin 24(CDH24). In further embodiments, cg06605933 references BolA familymember 1 (BOLA1). In further embodiments, cg09601629 referencescoiled-coil domain containing 15 (CCDC15). In further embodiments,cg13278334 references PIH1 domain containing 1 (PIH1D1). In furtherembodiments, cg11851098 references WBP2 N-terminal like (WBP2NL). Infurther embodiments, cg12188860 references topoisomerase (DNA) I,mitochondrial (TOP1MT). In further embodiments, cg25189085 referencesSH3 and cysteine rich domain 3 (STAC3). In further embodiments,cg25488021 references erythrocyte membrane protein band 4.1 like 2(EPB41L2).

In some embodiments, described herein is a method of determining theprognosis of a subject having breast cancer or monitoring theprogression of breast cancer in the subject, comprising generating amethylation profile comprising one or more genes selected from: VANGLplanar cell polarity protein 1 (VANGL1), G protein-coupled receptor 177(GPR177), chromosome 1 open reading frame 38 (Clorf38), PDZ domaincontaining 3 (PDZD3), fuzzy planar cell polarity protein (FUZ),8-oxoguanine DNA glycosylase (OGG1), T brachyury transcription factor(T), opsin 1 (cone pigments), short-wave-sensitive (OPN1SW), zinc fingerand BTB domain containing 25 (ZBTB25), and zinc finger AN1-typecontaining 1 (ZFAND1). In some instances, the methylation profilecomprises: VANGL planar cell polarity protein 1 (VANGL1), Gprotein-coupled receptor 177 (GPR177), chromosome 1 open reading frame38 (Clorf38), PDZ domain containing 3 (PDZD3), fuzzy planar cellpolarity protein (FUZ), 8-oxoguanine DNA glycosylase (OGG1), T brachyurytranscription factor (T), opsin 1 (cone pigments), short-wave-sensitive(OPN1SW), zinc finger and BTB domain containing 25 (ZBTB25), and zincfinger AN1-type containing 1 (ZFAND1). In some instances, themethylation profile comprises one or more genes selected from: cadherin24 (CDH24), BolA family member 1 (BOLA1), coiled-coil domain containing15 (CCDC15), PIH1 domain containing 1 (PIH1D1), WBP2 N-terminal like(WBP2NL), topoisomerase (DNA) I, mitochondrial (TOP1MT), SH3 andcysteine rich domain 3 (STAC3), erythrocyte membrane protein band 4.1like 2 (EPB41L2). In some instances, the methylation profile comprisesone or more genes selected from: cadherin 24 (CDH24), BolA family member1 (BOLA1), coiled-coil domain containing 15 (CCDC15), PIH1 domaincontaining 1 (PIH1D1), WBP2 N-terminal like (WBP2NL), topoisomerase(DNA) I, mitochondrial (TOP1MT), SH3 and cysteine rich domain 3 (STAC3),erythrocyte membrane protein band 4.1 like 2 (EPB41L2). In someinstances, the methylation profile comprises: cadherin 24 (CDH24), BolAfamily member 1 (BOLA1), coiled-coil domain containing 15 (CCDC15), PIH1domain containing 1 (PIH1D1), WBP2 N-terminal like (WBP2NL),topoisomerase (DNA) I, mitochondrial (TOP1MT), SH3 and cysteine richdomain 3 (STAC3), erythrocyte membrane protein band 4.1 like 2(EPB41L2).

Methylation Scores

In some instances, a methylation score is utilized to determine theprognosis of a subject. In some instances, prognosis refers to theprediction of the likelihood of cancer-attributable death orprogression, including recurrence, metastatic spread, and drugresistance, of breast cancer. The term “prediction” is used herein torefer to the likelihood that a subject will respond either favorably orunfavorably to a drug or set of drugs, and also the extent of thoseresponses, or that a subject will survive, following chemotherapy for acertain period of me without cancer recurrence and/or following surgery(e.g., removal of the spleen). In some instances, a methylation score isutilized to determine the prognosis of a subject having breast cancer orovarian cancer. In some cases, a methylation score is utilized todetermine the prognosis of a subject having breast cancer.

In some embodiments, a methylation score of from about 1.5 to about 4 isassociated with a “good” prognosis. In some instances, a “good”prognosis refers to the likelihood that a subject will likely respondfavorably to a drug or set of drugs, leading to a complete or partialremission of breast cancer or ovarian cancer or a decrease and/or a stopin the progression of breast cancer or ovarian cancer. In someinstances, a “good” prognosis refers to the survival of a subject offrom at least 1 month to at least 90 years. In some instances, a “good”prognosis refers to the survival of a subject in which the survival ofthe subject upon treatment is from at least 1 month to at least 90years. In some instances, the survival of a subject further refers to anextended survival rate of a subject receiving a treatment courserelative to a subject without receiving the same course of treatment. Insome cases, a “good” prognosis refers to an extended survival time of asubject receiving a treatment course relative to a subject withoutreceiving the same course of treatment.

In some instances, a methylation score of from about 1.5 to about 4 isindicative of a survival from at least 1 month to at least 90 years. Insome instances, a methylation score of from about 1.5 to about 4 isindicative of a survival of at least 2 months, 4 months, 6 months, 8months, 10 months, 1 year, 1.5 years, 2 years, 3 years, 4 years, 5years, 10 years, 15 years, 20 years, 30 years, 50 years, or more.

In some instances, a methylation score of from about 1.5 to about 3 isindicative of a survival from at least 1 month to at least 90 years. Insome instances, a methylation score of from about 1.5 to about 3 isindicative of a survival of at least 2 months, 4 months, 6 months, 8months, 10 months, 1 year, 1.5 years, 2 years, 3 years, 4 years, 5years, 10 years, 15 years, 20 years, 30 years, 50 years, or more.

In some instances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival from at least 1 month to at least 90 years. Insome instances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival of at least 2 months, 4 months, 6 months, 8months, 10 months, 1 year, 1.5 years, 2 years, 3 years, 4 years, 5years, 10 years, 15 years, 20 years, 30 years, 50 years, or more.

In some instances, a methylation score of from about 1.5 to about 2 isindicative of a survival from at least 1 month to at least 90 years. Insome instances, a methylation score of from about 1.5 to about 2 isindicative of a survival of at least 2 months, 4 months, 6 months, 8months, 10 months, 1 year, 1.5 years, 2 years, 3 years, 4 years, 5years, 10 years, 15 years, 20 years, 30 years, 50 years, or more.

In some embodiments, a methylation score of from about 1.5 to about 4 isassociated with a “good” prognosis in a subject having breast cancer. Insome embodiments, a methylation score of from about 1.5 to about 4, fromabout 1.5 to about 3.5, from about 1.5 to about 3, from about 1.5 toabout 2.5, or from about 1.5 to about 2 is associated with a “good”prognosis in a subject having breast cancer.

In some instances, a methylation score of from about 1.5 to about 3 isindicative of a survival from at least 1 month to at least 90 years in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 3 is indicative of a survival of at least 2months, 4 months, 6 months, 8 months, 10 months, 1 year, 1.5 years, 2years, 3 years, 4 years, 5 years, 10 years, 15 years, 20 years, 30years, 50 years, or more in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 3 isindicative of a survival for at least 2 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 3 is indicative of a survival for at least 3 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 3 is indicative of a survival for at least 4months in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 3 is indicative of asurvival for at least 5 months in a subject having breast cancer. Insome instances, a methylation score of from about 1.5 to about 3 isindicative of a survival for at least 6 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 3 is indicative of a survival for at least 8 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 3 is indicative of a survival for at least 10months in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 3 is indicative of asurvival for at least 1 year in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 3 isindicative of a survival for at least 1.5 years in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 3 is indicative of a survival for at least 2 years in a subjecthaving breast cancer. In some instances, a methylation score of fromabout 1.5 to about 3 is indicative of a survival for at least 2.5 yearsin a subject having breast cancer. In some instances, a methylationscore of from about 1.5 to about 3 is indicative of a survival for atleast 3 years in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 3 is indicative of asurvival for at least 4 years in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 3 isindicative of a survival for at least 5 years in a subject having breastcancer.

In some instances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival from at least 1 month to at least 90 years in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2.5 is indicative of a survival of at least 2months, 4 months, 6 months, 8 months, 10 months, 1 year, 1.5 years, 2years, 3 years, 4 years, 5 years, 10 years, 15 years, 20 years, 30years, 50 years, or more in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival for at least 2 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 2.5 is indicative of a survival for at least 3 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2.5 is indicative of a survival for at least 4months in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 2.5 is indicative of asurvival for at least 5 months in a subject having breast cancer. Insome instances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival for at least 6 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 2.5 is indicative of a survival for at least 8 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2.5 is indicative of a survival for at least 10months in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 2.5 is indicative of asurvival for at least 1 year in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival for at least 1.5 years in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 2.5 is indicative of a survival for at least 2 years in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2.5 is indicative of a survival for at least 2.5years in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 2.5 is indicative of asurvival for at least 3 years in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 2.5 isindicative of a survival for at least 4 years in a subject having breastcancer. In some instances, a methylation score of from about 1.5 toabout 2.5 is indicative of a survival for at least 5 years in a subjecthaving breast cancer.

In some instances, a methylation score of from about 1.5 to about 2 isindicative of a survival from at least 1 month to at least 90 years in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2 is indicative of a survival of at least 2months, 4 months, 6 months, 8 months, 10 months, 1 year, 1.5 years, 2years, 3 years, 4 years, 5 years, 10 years, 15 years, 20 years, 30years, 50 years, or more in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 2 isindicative of a survival for at least 2 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 2 is indicative of a survival for at least 3 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2 is indicative of a survival for at least 4months in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 2 is indicative of asurvival for at least 5 months in a subject having breast cancer. Insome instances, a methylation score of from about 1.5 to about 2 isindicative of a survival for at least 6 months in a subject havingbreast cancer. In some instances, a methylation score of from about 1.5to about 2 is indicative of a survival for at least 8 months in asubject having breast cancer. In some instances, a methylation score offrom about 1.5 to about 2 is indicative of a survival for at least 10months in a subject having breast cancer.

In some instances, a methylation score of from about 1.5 to about 2 isindicative of a survival for at least 1 year in a subject having breastcancer. In some instances, a methylation score of from about 1.5 toabout 2 is indicative of a survival for at least 1.5 years in a subjecthaving breast cancer. In some instances, a methylation score of fromabout 1.5 to about 2 is indicative of a survival for at least 2 years ina subject having breast cancer. In some instances, a methylation scoreof from about 1.5 to about 2 is indicative of a survival for at least2.5 years in a subject having breast cancer. In some instances, amethylation score of from about 1.5 to about 2 is indicative of asurvival for at least 3 years in a subject having breast cancer. In someinstances, a methylation score of from about 1.5 to about 2 isindicative of a survival for at least 4 years in a subject having breastcancer. In some instances, a methylation score of from about 1.5 toabout 2 is indicative of a survival for at least 5 years in a subjecthaving breast cancer.

In some embodiments, a methylation score of less than about 1.5 isassociated with a “poor” prognosis. In some instances, a “poor”prognosis refers to the likelihood that a subject will likely respondunfavorably to a drug or set of drugs, leading to a progression ofbreast cancer (e.g., progression to metastatic breast cancer) and/or torefractory of one or more therapeutic agents. In some instances, a“poor” prognosis refers to the likelihood that a subject will notrespond to a drug or set of drugs, leading to a progression of breastcancer. In some instances, a “poor” prognosis refers to the survival ofa subject of from less than 5 years to less than 1 month. In someinstances, a “poor” prognosis refers to the survival of a subject inwhich the survival of the subject upon treatment is from less than 5years to less than 1 month. In some instances, a “poor” prognosisfurther refers to the likelihood that a subject will develop arefractory breast cancer or refractory ovarian cancer toward one or moredrugs.

In some instances, a methylation score of less than 1.5 is indicative ofa survival of from less than 5 years to less than 1 month. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 5 years, 4 years, 3 years, 2 years, 1.5 years, 1year, 10 months, 8 months, 6 months, 4 months, or 2 months.

In some embodiments, a methylation score of less than about 1.5 isassociated with a “poor” prognosis in a subject having breast cancer. Insome embodiments, a methylation score of less than about 1.5 isassociated with a “poor” prognosis in a subject having breast cancer.

In some instances, a methylation score of less than 1.5 is indicative ofa survival of from less than 5 years to less than 1 month in a subjecthaving breast cancer. In some instances, a methylation score of lessthan 1.5 is indicative of a survival of less than 5 years, 4 years, 3years, 2 years, 1.5 years, 1 year, 10 months, 8 months, 6 months, 4months, or 2 months in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 5 years in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 4 years in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 3 years in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 2.5 years in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 2 years in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 1.5 years in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 1 year in a subject having breast cancer. In someinstances, a methylation score of less than 1.5 is indicative of asurvival of less than 6 months in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 5 months in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 4 months in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 3 months in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 2 months in a subject having breast cancer. Insome instances, a methylation score of less than 1.5 is indicative of asurvival of less than 1 month in a subject having breast cancer.

In some instances, one or more samples are obtained from a subjectduring the course of a treatment to monitor the progression of breastcancer in the subject. In some instances, the subject initially has amethylation score of from about 1.5 to about 3 and progressively duringeach subsequent testing has a lower methylation score. For example, asubject initially has a methylation score of 3 and during subsequenttestings, has methylation scores of 2.5, 2, 1.5, or 1. In such cases,the subject is further tested to determine the progression of breastcancer (e.g., whether breast cancer has progressed into a metastaticstate or into a refractory state) and a treatment course is optionallyaltered based on the changes in prognosis.

In some embodiments, the methylation score is calculated based on modelfor a survival analysis. In some instances, a survival analysis is astatistic analysis for analyzing the expected duration of time until oneor more events of interest happen. In some instances, survival analysiscomprises Cox proportional hazards (PH) regression analysis, log-ranktest or a product limit estimator. In some instances, the methylationscore is calculated based on Cox proportional hazards (PH) regressionanalysis, log-rank test or product limit estimator. In some instances,the methylation score is calculated based on Cox proportional hazards(PH) regression analysis. In some embodiments, the methylation score isfurther calculated based on a log-rank test. In some instances, thelog-rank test is a hypothesis test to compare the survival distributionof two samples (e.g., a training set and a validation set). In someinstances, the log-rank test is also referred to as a Mantel-Cox test ora time-stratified Cochran-Mantel-Haenszel test. In some instances, themethylation score is additionally calculated based on a product limitestimator. A product limit estimator (also known as Kaplan-Meierestimator) is a non-parametric statistic used to estimate the survivalfunction from lifetime data. In some embodiments, the methylation scoreis initially calculated based on Cox proportional hazards (PH)regression analysis and then reprocessed with a log-rank test.

Control

In some embodiments, a control is a methylation value, methylationlevel, or methylation profile of a sample. In some instances, thecontrol comprises a set of methylation profiles, wherein each saidmethylation profile is generated from a biological sample obtained froma known cancer type. In some cases, the known cancer type is breastcancer or ovarian cancer. In some cases, the known cancer type is breastcancer. In some cases, the known cancer type is a relapsed or refractorybreast cancer. In other cases, the known cancer type is a metastaticbreast cancer. In some cases, the known cancer type is ductal carcinomain situ, invasive or infiltrating ductal carcinoma, invasive orinfiltrating lobular carcinoma, lobular carcinoma in situ, inflammatorybreast cancer, Paget disease of the nipple, Phyllodes tumor,angiosarcoma, metaplastic carcinoma, low-grade adenosquamous carcinoma,spindle cell carcinoma of the breast, squamous carcinoma,triple-negative breast cancer, or mixed carcinoma. In some cases, theknown cancer type is invasive ductal carcinoma comprises tubularcarcinoma of the breast, medullary carcinoma of the breast, mucinous (orcolloid) carcinoma of the breast, papillary carcinoma of the breast,micropapillary carcinoma, or cribriform carcinoma of the breast.

In some cases, the known cancer type is ovarian cancer. In some cases,the known cancer type is a relapsed or refractory ovarian cancer. Inother cases, the known cancer type is a metastatic ovarian cancer. Insome cases, the known cancer type is epithelial ovarian cancer, stromalcell ovarian tumors, germ cell ovarian tumors, borderline ovariantumors, small cell ovarian carcinoma, neuro-endocrine carcinomas,squamous cell carcinoma, struma ovarii malignum or psammocarcinoma.

Probes

In some embodiments, one or more probes described above comprise astructure of Formula I:

wherein:

A is a first target-binding region;

B is a second target-binding region; and

L is a linker region;

wherein A comprises at least 70%, 80%, 90%, 95%, or 99% sequenceidentity to at least 30 contiguous nucleotides starting at position 1from the 5′ terminus of a sequence selected from SEQ ID NOs: 1-37; Bcomprises at least 70%, 80%, 90%, 95%, or 99% sequence identity to atleast 12 contiguous nucleotides starting at position 1′ from the 3′terminus of the same sequence selected from SEQ ID NOs: 1-37; andwherein L is attached to A; and B is attached to either A or L.

In some instances, L is attached to A and B is attached to L. In somecases, A, B, and L are attached as illustrated in Formula Ia:

In some embodiments, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 35 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 40 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 45 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 50 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 55 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 60 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 65 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 70 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 80 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37. In some cases, A comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 90 contiguous nucleotides starting atposition 1 from the 5′ terminus of a sequence selected from SEQ ID NOs:1-37.

In some embodiments, B comprises at least 70%, 80%, 90%, 95%, or 99%sequence identity to at least 14 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 15 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 18 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 20 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 22 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 25 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 28 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 30 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 35 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 40 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 45 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 50 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 55 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 60 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 65 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 70 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 80 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37. In some cases, B comprises at least 70%, 80%, 90%, 95%, or99% sequence identity to at least 90 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37.

In some instances, a probe described above is used in a next generationsequencing reaction to generate a CpG methylation data. In someinstances, the probe is used in a solution-based next generationsequencing reaction to generate a CpG methylation data. In someinstances, the next generation sequencing reaction comprises 454 LifeSciences platform (Roche, Branford, Conn.); Illumina's Genome Analyzer,GoldenGate Methylation Assay, or Infinium Methylation Assays, i.e.,Infinium HumanMethylation 27K BeadArray or VeraCode GoldenGatemethylation array (Illumina, San Diego, Calif.); QX200™ Droplet Digital™PCR System from Bio-Rad; DNA Sequencing by Ligation, SOLiD System(Applied Biosystems/Life Technologies); the Helicos True Single MoleculeDNA sequencing technology; semiconductor sequencing (Ion Torrent;Personal Genome Machine); DNA nanoball sequencing; sequencing usingtechnology from Dover Systems (Polonator), and technologies that do notrequire amplification or otherwise transform native DNA prior tosequencing (e.g., Pacific Biosciences and Helicos), such asnanopore-based strategies (e.g., Oxford Nanopore, Genia Technologies,and Nabsys). In some instances, the solution-based next generationsequencing reaction is a droplet digital PCR sequencing method.

In some instances, each probe correlates to a CpG site. In someinstances, each probe correlates to a biomarker (e.g., CpG site) asillustrated in Table 5.

In some instances, L is between 10 and 60, 15 and 55, 20 and 50, 25 and45, and 30 and 40 nucleotides in length. In some instances, L is about15, 20, 25, 30, 35, 40, 45, 50, 55, or 60 nucleotides in length.

In some instances, L further comprises an adaptor region. In someinstances, the adaptor region comprises a sequence used to identify eachprobe. In some instances as illustrated in Table 5, the adaptor regionin each illustrative sequence is reflected by a series of N, in whicheach N is A, T, G, or C.

In some embodiments, a probe described herein comprises at least 50%,60%, 70%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises at least 50% sequence identity to asequence selected from SEQ ID NOs: 1-37. In some instances, the probecomprises at least 60% sequence identity to a sequence selected from SEQID NOs: 1-37. In some instances, the probe comprises at least 70%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises at least 80% sequence identity to asequence selected from SEQ ID NOs: 1-37. In some instances, the probecomprises at least 85% sequence identity to a sequence selected from SEQID NOs: 1-37. In some instances, the probe comprises at least 90%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises at least 91% sequence identity to asequence selected from SEQ ID NOs: 1-37. In some instances, the probecomprises at least 92% sequence identity to a sequence selected from SEQID NOs: 1-37. In some instances, the probe comprises at least 93%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises at least 94% sequence identity to asequence selected from SEQ ID NOs: 1-37. In some instances, the probecomprises at least 95% sequence identity to a sequence selected from SEQID NOs: 1-37. In some instances, the probe comprises at least 96%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises at least 97% sequence identity to asequence selected from SEQ ID NOs: 1-37. In some instances, the probecomprises at least 98% sequence identity to a sequence selected from SEQID NOs: 1-37. In some instances, the probe comprises at least 99%sequence identity to a sequence selected from SEQ ID NOs: 1-37. In someinstances, the probe comprises 100% sequence identity to a sequenceselected from SEQ ID NOs: 1-37. In some instances, the probe consists ofa sequence selected from SEQ ID NOs: 1-37.

In some cases, a probe described above is utilized in a digital PCRsequencing method. In some cases, the probe is utilized in a dropletdigital PCR (ddPCR) sequencing method.

Detection Methods

In some embodiments, a number of methods are utilized to measure,detect, determine, identify, and characterize the methylationstatus/level of a gene or a biomarker (e.g., CpG island-containingregion/fragment) in identifying a subject as having breast cancer orovarian cancer, determining the breast cancer or ovarian cancer subtype,the prognosis of a subject having breast cancer or ovarian cancer, andthe progression or regression of breast cancer or ovarian cancer insubject in the presence of a therapeutic agent.

In some instances, the methylation profile is generated from abiological sample isolated from an individual. In some embodiments, thebiological sample is a biopsy. In some instances, the biological sampleis a tissue sample. In some instances, the biological sample is a tissuebiopsy sample. In some instances, the biological sample is a bloodsample. In other instances, the biological sample is a cell-freebiological sample. In other instances, the biological sample is acirculating tumor DNA sample. In one embodiment, the biological sampleis a cell-free biological sample containing circulating tumor DNA.

In some embodiments, a biomarker (or an epigenetic marker) is obtainedfrom a liquid sample. In some embodiments, the liquid sample comprisesblood and other liquid samples of biological origin (including, but notlimited to, peripheral blood, sera, plasma, ascites, urine,cerebrospinal fluid (CSF), sputum, saliva, bone marrow, synovial fluid,aqueous humor, amniotic fluid, cerumen, breast milk, broncheoalveolarlavage fluid, semen, prostatic fluid, cowper's fluid or pre-ejaculatoryfluid, female ejaculate, sweat, tears, cyst fluid, pleural andperitoneal fluid, pericardial fluid, ascites, lymph, chyme, chyle, bile,interstitial fluid, menses, pus, sebum, vomit, vaginalsecretions/flushing, synovial fluid, mucosal secretion, stool water,pancreatic juice, lavage fluids from sinus cavities, bronchopulmonaryaspirates, blastocyl cavity fluid, or umbilical cord blood. In someembodiments, the biological fluid is blood, a blood derivative or ablood fraction, e.g., serum or plasma. In a specific embodiment, asample comprises a blood sample. In another embodiment, a serum sampleis used. In another embodiment, a sample comprises urine. In someembodiments, the liquid sample also encompasses a sample that has beenmanipulated in any way after their procurement, such as bycentrifugation, filtration, precipitation, dialysis, chromatography,treatment with reagents, washed, or enriched for certain cellpopulations.

In some embodiments, a biomarker (or an epigenetic marker) is obtainedfrom a tissue sample. In some instances, a tissue corresponds to anycell(s). Different types of tissue correspond to different types ofcells (e.g., liver, lung, blood, connective tissue, and the like), butalso healthy cells vs. tumor cells or to tumor cells at various stagesof neoplasia, or to displaced malignant tumor cells. In someembodiments, a tissue sample further encompasses a clinical sample, andalso includes cells in culture, cell supernatants, organs, and the like.Samples also comprise fresh-frozen and/or formalin-fixed,paraffin-embedded tissue blocks, such as blocks prepared from clinicalor pathological biopsies, prepared for pathological analysis or study byimmunohistochemistry.

In some embodiments, a biomarker (or an epigenetic marker) is methylatedor unmethylated in a normal sample (e.g., normal or control tissuewithout disease, or normal or control body fluid, stool, blood, serum,amniotic fluid), most importantly in healthy stool, blood, serum,amniotic fluid or other body fluid. In other embodiments, a biomarker(or an epigenetic marker) is hypomethylated or hypermethylated in asample from a patient having or at risk of a disease (e.g., one or moreindications described herein); for example, at a decreased or increased(respectively) methylation frequency of at least about 50%, at leastabout 60%, at least about 70%, at least about 75%, at least about 80%,at least about 85%, at least about 90%, at least about 95%, or about100% in comparison to a normal sample. In one embodiment, a sample isalso hypomethylated or hypermethylated in comparison to a previouslyobtained sample analysis of the same patient having or at risk of adisease (e.g., one or more indications described herein), particularlyto compare progression of a disease.

In some embodiments, a methylome comprises a set of epigenetic markersor biomarkers, such as a biomarker described above. In some instances, amethylome that corresponds to the methylome of a tumor of an organism(e.g., a human) is classified as a tumor methylome. In some cases, atumor methylome is determined using tumor tissue or cell-free (orprotein-free) tumor DNA in a biological sample. Other examples ofmethylomes of interest include the methylomes of organs that contributeDNA into a bodily fluid (e.g. methylomes of tissue such as brain,breast, lung, the prostate, and the kidneys, plasma, etc.).

In some embodiments, a plasma methylome is the methylome determined fromthe plasma or serum of an animal (e.g., a human). In some instances, theplasma methylome is an example of a cell-free or protein-free methylomesince plasma and serum include cell-free DNA. The plasma methylome isalso an example of a mixed methylome since it is a mixture of tumor andother methylomes of interest. In some instances, the urine methylome isdetermined from the urine sample of a subject. In some cases, a cellularmethylome corresponds to the methylome determined from cells (e.g.,blood cells) of the patient. The methylome of the blood cells is calledthe blood cell methylome (or blood methylome).

In some embodiments, DNA (e.g., genomic DNA such as extracted genomicDNA or treated genomic DNA) is isolated by any means standard in theart, including the use of commercially available kits. Briefly, whereinthe DNA of interest is encapsulated in by a cellular membrane thebiological sample is disrupted and lysed by enzymatic, chemical, ormechanical means. In some cases, the DNA solution is then cleared ofproteins and other contaminants e.g. by digestion with proteinase K. TheDNA is then recovered from the solution. In such cases, this is carriedout by means of a variety of methods including salting out, organicextraction or binding of the DNA to a solid phase support. In someinstances, the choice of method is affected by several factors includingtime, expense and required quantity of DNA.

Wherein the sample DNA is not enclosed in a membrane (e.g. circulatingDNA from a cell free sample such as blood or urine) methods standard inthe art for the isolation and/or purification of DNA are optionallyemployed (See, for example, Bettegowda et al. Detection of CirculatingTumor DNA in Early- and Late-Stage Human Malignancies. Sci. Transl. Med,6(224): ra24. 2014). Such methods include the use of a proteindegenerating reagent e.g. chaotropic salt e.g. guanidine hydrochlorideor urea; or a detergent e.g. sodium dodecyl sulphate (SDS), cyanogenbromide. Alternative methods include but are not limited to ethanolprecipitation or propanol precipitation, vacuum concentration amongstothers by means of a centrifuge. In some cases, the person skilled inthe art also make use of devices such as filter devices e.g.ultrafiltration, silica surfaces or membranes, magnetic particles,polystyrol particles, polystyrol surfaces, positively charged surfaces,and positively charged membranes, charged membranes, charged surfaces,charged switch membranes, charged switched surfaces.

In some instances, once the nucleic acids have been extracted,methylation analysis is carried out by any means known in the art. Avariety of methylation analysis procedures are known in the art and maybe used to practice the methods disclosed herein. These assays allow fordetermination of the methylation state of one or a plurality of CpGsites within a tissue sample. In addition, these methods may be used forabsolute or relative quantification of methylated nucleic acids. Suchmethylation assays involve, among other techniques, two major steps. Thefirst step is a methylation specific reaction or separation, such as (i)bisulfite treatment, (ii) methylation specific binding, or (iii)methylation specific restriction enzymes. The second major step involves(i) amplification and detection, or (ii) direct detection, by a varietyof methods such as (a) PCR (sequence-specific amplification) such asTaqman®, (b) DNA sequencing of untreated and bisulfite-treated DNA, (c)sequencing by ligation of dye-modified probes (including cyclic ligationand cleavage), (d) pyrosequencing, (e) single-molecule sequencing, (f)mass spectroscopy, or (g) Southern blot analysis.

Additionally, restriction enzyme digestion of PCR products amplifiedfrom bisulfite-converted DNA may be used, e.g., the method described bySadri and Hornsby (1996, Nucl. Acids Res. 24:5058-5059), or COBRA(Combined Bisulfite Restriction Analysis) (Xiong and Laird, 1997,Nucleic Acids Res. 25:2532-2534). COBRA analysis is a quantitativemethylation assay useful for determining DNA methylation levels atspecific gene loci in small amounts of genomic DNA. Briefly, restrictionenzyme digestion is used to reveal methylation-dependent sequencedifferences in PCR products of sodium bisulfite-treated DNA.Methylation-dependent sequence differences are first introduced into thegenomic DNA by standard bisulfite treatment according to the proceduredescribed by Frommer et al. (Frommer et al, 1992, Proc. Nat. Acad. Sci.USA, 89, 1827-1831). PCR amplification of the bisulfite converted DNA isthen performed using primers specific for the CpG sites of interest,followed by restriction endonuclease digestion, gel electrophoresis, anddetection using specific, labeled hybridization probes. Methylationlevels in the original DNA sample are represented by the relativeamounts of digested and undigested PCR product in a linearlyquantitative fashion across a wide spectrum of DNA methylation levels.In addition, this technique can be reliably applied to DNA obtained frommicro-dissected paraffin-embedded tissue samples. Typical reagents(e.g., as might be found in a typical COBRA-based kit) for COBRAanalysis may include, but are not limited to: PCR primers for specificgene (or methylation-altered DNA sequence or CpG island); restrictionenzyme and appropriate buffer; gene-hybridization oligo; controlhybridization oligo; kinase labeling kit for oligo probe; andradioactive nucleotides. Additionally, bisulfite conversion reagents mayinclude: DNA denaturation buffer; sulfo nation buffer; DNA recoveryreagents or kits (e.g., precipitation, ultrafiltration, affinitycolumn); desulfonation buffer; and DNA recovery components.

In an embodiment, the methylation profile of selected CpG sites isdetermined using methylation-Specific PCR (MSP). MSP allows forassessing the methylation status of virtually any group of CpG siteswithin a CpG island, independent of the use of methylation-sensitiverestriction enzymes (Herman et al, 1996, Proc. Nat. Acad. Sci. USA, 93,9821-9826; U.S. Pat. Nos. 5,786,146, 6,017,704, 6,200,756, 6,265,171(Herman and Baylin); U.S. Pat. Pub. No. 2010/0144836 (Van Engeland etal)). Briefly, DNA is modified by a deaminating agent such as sodiumbisulfite to convert unmethylated, but not methylated cytosines touracil, and subsequently amplified with primers specific for methylatedversus unmethylated DNA. In some instances, typical reagents (e.g., asmight be found in a typical MSP-based kit) for MSP analysis include, butare not limited to: methylated and unmethylated PCR primers for specificgene (or methylation-altered DNA sequence or CpG island), optimized PCRbuffers and deoxynucleotides, and specific probes. The ColoSure™ test isa commercially available test for colon cancer based on the MSPtechnology and measurement of methylation of the vimentin gene(Itzkowitz et al, 2007, Clin Gastroenterol. Hepatol. 5(1), 111-117).Alternatively, one may use quantitative multiplexed methylation specificPCR (QM-PCR), as described by Fackler et al. Fackler et al, 2004, CancerRes. 64(13) 4442-4452; or Fackler et al, 2006, Clin. Cancer Res. 12(11Pt 1) 3306-3310.

In an embodiment, the methylation profile of selected CpG sites isdetermined using MethyLight and/or Heavy Methyl Methods. The MethyLightand Heavy Methyl assays are a high-throughput quantitative methylationassay that utilizes fluorescence-based real-time PCR (Taq Man®)technology that requires no further manipulations after the PCR step(Eads, C. A. et al, 2000, Nucleic Acid Res. 28, e 32; Cottrell et al,2007, J. Urology 177, 1753, U.S. Pat. No. 6,331,393 (Laird et al)).Briefly, the MethyLight process begins with a mixed sample of genomicDNA that is converted, in a sodium bisulfite reaction, to a mixed poolof methylation-dependent sequence differences according to standardprocedures (the bisulfite process converts unmethylated cytosineresidues to uracil). Fluorescence-based PCR is then performed either inan “unbiased” (with primers that do not overlap known CpG methylationsites) PCR reaction, or in a “biased” (with PCR primers that overlapknown CpG dinucleotides) reaction. In some cases, sequencediscrimination occurs either at the level of the amplification processor at the level of the fluorescence detection process, or both. In somecases, the MethyLight assay is used as a quantitative test formethylation patterns in the genomic DNA sample, wherein sequencediscrimination occurs at the level of probe hybridization. In thisquantitative version, the PCR reaction provides for unbiasedamplification in the presence of a fluorescent probe that overlaps aparticular putative methylation site. An unbiased control for the amountof input DNA is provided by a reaction in which neither the primers, northe probe overlie any CpG dinucleotides. Alternatively, a qualitativetest for genomic methylation is achieved by probing of the biased PCRpool with either control oligonucleotides that do not “cover” knownmethylation sites (a fluorescence-based version of the “MSP” technique),or with oligonucleotides covering potential methylation sites. Typicalreagents (e.g., as might be found in a typical MethyLight-based kit) forMethyLight analysis include, but are not limited to: PCR primers forspecific gene (or methylation-altered DNA sequence or CpG island);TaqMan® probes; optimized PCR buffers and deoxynucleotides; and Taqpolymerase.

Quantitative MethyLight uses bisulfite to convert genomic DNA and themethylated sites are amplified using PCR with methylation independentprimers. Detection probes specific for the methylated and unmethylatedsites with two different fluorophores provides simultaneous quantitativemeasurement of the methylation. The Heavy Methyl technique begins withbisulfate conversion of DNA. Next specific blockers prevent theamplification of unmethylated DNA. Methylated genomic DNA does not bindthe blockers and their sequences will be amplified. The amplifiedsequences are detected with a methylation specific probe. (Cottrell etal, 2004, Nuc. Acids Res. 32:e10).

The Ms-SNuPE technique is a quantitative method for assessingmethylation differences at specific CpG sites based on bisulfitetreatment of DNA, followed by single-nucleotide primer extension(Gonzalgo and Jones, 1997, Nucleic Acids Res. 25, 2529-2531). Briefly,genomic DNA is reacted with sodium bisulfite to convert unmethylatedcytosine to uracil while leaving 5-methylcytosine unchanged.Amplification of the desired target sequence is then performed using PCRprimers specific for bisulfite-converted DNA, and the resulting productis isolated and used as a template for methylation analysis at the CpGsite(s) of interest. In some cases, small amounts of DNA are analyzed(e.g., micro-dissected pathology sections), and the method avoidsutilization of restriction enzymes for determining the methylationstatus at CpG sites. Typical reagents (e.g., as is found in a typicalMs-SNuPE-based kit) for Ms-SNuPE analysis include, but are not limitedto: PCR primers for specific gene (or methylation-altered DNA sequenceor CpG island); optimized PCR buffers and deoxynucleotides; gelextraction kit; positive control primers; Ms-SNuPE primers for specificgene; reaction buffer (for the Ms-SNuPE reaction); and radioactivenucleotides. Additionally, bisulfite conversion reagents may include:DNA denaturation buffer; sulfonation buffer; DNA recovery regents or kit(e.g., precipitation, ultrafiltration, affinity column); desulfonationbuffer; and DNA recovery components.

In another embodiment, the methylation status of selected CpG sites isdetermined using differential Binding-based Methylation DetectionMethods. For identification of differentially methylated regions, oneapproach is to capture methylated DNA. This approach uses a protein, inwhich the methyl binding domain of MBD2 is fused to the Fc fragment ofan antibody (MBD-FC) (Gebhard et al, 2006, Cancer Res. 66:6118-6128; andPCT Pub. No. WO 2006/056480 A2 (Relhi)). This fusion protein has severaladvantages over conventional methylation specific antibodies. The MBD FChas a higher affinity to methylated DNA and it binds double strandedDNA. Most importantly the two proteins differ in the way they bind DNA.Methylation specific antibodies bind DNA stochastically, which meansthat only a binary answer can be obtained. The methyl binding domain ofMBD-FC, on the other hand, binds DNA molecules regardless of theirmethylation status. The strength of this protein—DNA interaction isdefined by the level of DNA methylation. After binding genomic DNA,eluate solutions of increasing salt concentrations can be used tofractionate non-methylated and methylated DNA allowing for a morecontrolled separation (Gebhard et al, 2006, Nucleic Acids Res. 34: e82).Consequently this method, called Methyl-CpG immunoprecipitation (MCIP),not only enriches, but also fractionates genomic DNA according tomethylation level, which is particularly helpful when the unmethylatedDNA fraction should be investigated as well.

In an alternative embodiment, a 5-methyl cytidine antibody to bind andprecipitate methylated DNA. Antibodies are available from Abeam(Cambridge, Mass.), Diagenode (Sparta, N.J.) or Eurogentec (c/o AnaSpec,Fremont, Calif.). Once the methylated fragments have been separated theymay be sequenced using microarray based techniques such as methylatedCpG-island recovery assay (MIRA) or methylated DNA immunoprecipitation(MeDIP) (Pelizzola et al, 2008, Genome Res. 18, 1652-1659; O'Geen et al,2006, BioTechniques 41(5), 577-580, Weber et al, 2005, Nat. Genet. 37,853-862; Horak and Snyder, 2002, Methods Enzymol, 350, 469-83; Lieb,2003, Methods Mol Biol, 224, 99-109). Another technique is methyl-CpGbinding domain column/segregation of partly melted molecules (MBD/SPM,Shiraishi et al, 1999, Proc. Natl. Acad. Sci. USA 96(6):2913-2918).

In some embodiments, methods for detecting methylation include randomlyshearing or randomly fragmenting the genomic DNA, cutting the DNA with amethylation-dependent or methylation-sensitive restriction enzyme andsubsequently selectively identifying and/or analyzing the cut or uncutDNA. Selective identification can include, for example, separating cutand uncut DNA (e.g., by size) and quantifying a sequence of interestthat was cut or, alternatively, that was not cut. See, e.g., U.S. Pat.No. 7,186,512. Alternatively, the method can encompass amplifying intactDNA after restriction enzyme digestion, thereby only amplifying DNA thatwas not cleaved by the restriction enzyme in the area amplified. See,e.g., U.S. Pat. Nos. 7,910,296; 7,901,880; and 7,459,274. In someembodiments, amplification can be performed using primers that are genespecific.

For example, there are methyl-sensitive enzymes that preferentially orsubstantially cleave or digest at their DNA recognition sequence if itis non-methylated. Thus, an unmethylated DNA sample is cut into smallerfragments than a methylated DNA sample. Similarly, a hypermethylated DNAsample is not cleaved. In contrast, there are methyl-sensitive enzymesthat cleave at their DNA recognition sequence only if it is methylated.Methyl-sensitive enzymes that digest unmethylated DNA suitable for usein methods of the technology include, but are not limited to, Hpall,Hhal, Maell, BstUI and Acil. In some instances, an enzyme that is usedis Hpall that cuts only the unmethylated sequence CCGG. In otherinstances, another enzyme that is used is Hhal that cuts only theunmethylated sequence GCGC. Both enzymes are available from New EnglandBioLabs®, Inc. Combinations of two or more methyl-sensitive enzymes thatdigest only unmethylated DNA are also used. Suitable enzymes that digestonly methylated DNA include, but are not limited to, Dpnl, which onlycuts at fully methylated 5′-GATC sequences, and McrBC, an endonuclease,which cuts DNA containing modified cytosines (5-methylcytosine or5-hydroxymethylcytosine or N4-methylcytosine) and cuts at recognitionsite 5′ . . . PumC(N4o-3ooo) PumC . . . 3′ (New England BioLabs, Inc.,Beverly, Mass.). Cleavage methods and procedures for selectedrestriction enzymes for cutting DNA at specific sites are well known tothe skilled artisan. For example, many suppliers of restriction enzymesprovide information on conditions and types of DNA sequences cut byspecific restriction enzymes, including New England BioLabs, Pro-MegaBiochems, Boehringer-Mannheim, and the like. Sambrook et al. (SeeSambrook et al. Molecular Biology: A Laboratory Approach, Cold SpringHarbor, N.Y. 1989) provide a general description of methods for usingrestriction enzymes and other enzymes.

In some instances, a methylation-dependent restriction enzyme is arestriction enzyme that cleaves or digests DNA at or in proximity to amethylated recognition sequence, but does not cleave DNA at or near thesame sequence when the recognition sequence is not methylated.Methylation-dependent restriction enzymes include those that cut at amethylated recognition sequence (e.g., Dpnl) and enzymes that cut at asequence near but not at the recognition sequence (e.g., McrBC). Forexample, McrBC's recognition sequence is 5′ RmC (N40-3000) RmC 3′ where“R” is a purine and “mC” is a methylated cytosine and “N40-3000”indicates the distance between the two RmC half sites for which arestriction event has been observed. McrBC generally cuts close to onehalf-site or the other, but cleavage positions are typically distributedover several base pairs, approximately 30 base pairs from the methylatedbase. McrBC sometimes cuts 3’ of both half sites, sometimes 5′ of bothhalf sites, and sometimes between the two sites. Exemplarymethylation-dependent restriction enzymes include, e.g., McrBC, McrA,MrrA, Bisl, Glal and Dpnl. One of skill in the art will appreciate thatany methylation-dependent restriction enzyme, including homologs andorthologs of the restriction enzymes described herein, is also suitablefor use with one or more methods described herein.

In some cases, a methylation-sensitive restriction enzyme is arestriction enzyme that cleaves DNA at or in proximity to anunmethylated recognition sequence but does not cleave at or in proximityto the same sequence when the recognition sequence is methylated.Exemplary methylation-sensitive restriction enzymes are described in,e.g., McClelland et al, 22(17) NUCLEIC ACIDS RES. 3640-59 (1994).Suitable methylation-sensitive restriction enzymes that do not cleaveDNA at or near their recognition sequence when a cytosine within therecognition sequence is methylated at position C5 include, e.g., Aat II,Aci I, Acd I, Age I, Alu I, Asc I, Ase I, AsiS I, Bbe I, BsaA I, BsaH I,BsiE I, BsiW I, BsrF I, BssH II, BssK I, BstB I, BstN I, BstU I, Cla I,Eae I, Eag I, Fau I, Fse I, Hha I, HinP1 I, HinC II, Hpa II, Hpy99 I,HpyCH4 IV, Kas I, Mbo I, Mlu I, MapAl I, Msp I, Nae I, Nar I, Not I, PmlI, Pst I, Pvu I, Rsr II, Sac II, Sap I, Sau3A I, Sfl I, Sfo I, SgrA I,Sma I, SnaB I, Tsc I, Xma I, and Zra I. Suitable methylation-sensitiverestriction enzymes that do not cleave DNA at or near their recognitionsequence when an adenosine within the recognition sequence is methylatedat position N6 include, e.g., Mbo I. One of skill in the art willappreciate that any methylation-sensitive restriction enzyme, includinghomologs and orthologs of the restriction enzymes described herein, isalso suitable for use with one or more of the methods described herein.One of skill in the art will further appreciate that amethylation-sensitive restriction enzyme that fails to cut in thepresence of methylation of a cytosine at or near its recognitionsequence may be insensitive to the presence of methylation of anadenosine at or near its recognition sequence. Likewise, amethylation-sensitive restriction enzyme that fails to cut in thepresence of methylation of an adenosine at or near its recognitionsequence may be insensitive to the presence of methylation of a cytosineat or near its recognition sequence. For example, Sau3AI is sensitive(i.e., fails to cut) to the presence of a methylated cytosine at or nearits recognition sequence, but is insensitive (i.e., cuts) to thepresence of a methylated adenosine at or near its recognition sequence.One of skill in the art will also appreciate that somemethylation-sensitive restriction enzymes are blocked by methylation ofbases on one or both strands of DNA encompassing of their recognitionsequence, while other methylation-sensitive restriction enzymes areblocked only by methylation on both strands, but can cut if arecognition site is hemi-methylated.

In alternative embodiments, adaptors are optionally added to the ends ofthe randomly fragmented DNA, the DNA is then digested with amethylation-dependent or methylation-sensitive restriction enzyme, andintact DNA is subsequently amplified using primers that hybridize to theadaptor sequences. In this case, a second step is performed to determinethe presence, absence or quantity of a particular gene in an amplifiedpool of DNA. In some embodiments, the DNA is amplified using real-time,quantitative PCR.

In other embodiments, the methods comprise quantifying the averagemethylation density in a target sequence within a population of genomicDNA. In some embodiments, the method comprises contacting genomic DNAwith a methylation-dependent restriction enzyme or methylation-sensitiverestriction enzyme under conditions that allow for at least some copiesof potential restriction enzyme cleavage sites in the locus to remainuncleaved; quantifying intact copies of the locus; and comparing thequantity of amplified product to a control value representing thequantity of methylation of control DNA, thereby quantifying the averagemethylation density in the locus compared to the methylation density ofthe control DNA.

In some instances, the quantity of methylation of a locus of DNA isdetermined by providing a sample of genomic DNA comprising the locus,cleaving the DNA with a restriction enzyme that is eithermethylation-sensitive or methylation-dependent, and then quantifying theamount of intact DNA or quantifying the amount of cut DNA at the DNAlocus of interest. The amount of intact or cut DNA will depend on theinitial amount of genomic DNA containing the locus, the amount ofmethylation in the locus, and the number (i.e., the fraction) ofnucleotides in the locus that are methylated in the genomic DNA. Theamount of methylation in a DNA locus can be determined by comparing thequantity of intact DNA or cut DNA to a control value representing thequantity of intact DNA or cut DNA in a similarly-treated DNA sample. Thecontrol value can represent a known or predicted number of methylatednucleotides. Alternatively, the control value can represent the quantityof intact or cut DNA from the same locus in another (e.g., normal,non-diseased) cell or a second locus.

By using at least one methylation-sensitive or methylation-dependentrestriction enzyme under conditions that allow for at least some copiesof potential restriction enzyme cleavage sites in the locus to remainuncleaved and subsequently quantifying the remaining intact copies andcomparing the quantity to a control, average methylation density of alocus can be determined. If the methylation-sensitive restriction enzymeis contacted to copies of a DNA locus under conditions that allow for atleast some copies of potential restriction enzyme cleavage sites in thelocus to remain uncleaved, then the remaining intact DNA will bedirectly proportional to the methylation density, and thus may becompared to a control to determine the relative methylation density ofthe locus in the sample. Similarly, if a methylation-dependentrestriction enzyme is contacted to copies of a DNA locus underconditions that allow for at least some copies of potential restrictionenzyme cleavage sites in the locus to remain uncleaved, then theremaining intact DNA will be inversely proportional to the methylationdensity, and thus may be compared to a control to determine the relativemethylation density of the locus in the sample. Such assays aredisclosed in, e.g., U.S. Pat. No. 7,910,296.

The methylated CpG island amplification (MCA) technique is a method thatcan be used to screen for altered methylation patterns in genomic DNA,and to isolate specific sequences associated with these changes (Toyotaet al, 1999, Cancer Res. 59, 2307-2312, U.S. Pat. No. 7,700,324 (Issa etal)). Briefly, restriction enzymes with different sensitivities tocytosine methylation in their recognition sites are used to digestgenomic DNAs from primary tumors, cell lines, and normal tissues priorto arbitrarily primed PCR amplification. Fragments that showdifferential methylation are cloned and sequenced after resolving thePCR products on high-resolution polyacrylamide gels. The clonedfragments are then used as probes for Southern analysis to confirmdifferential methylation of these regions. Typical reagents (e.g., asmight be found in a typical MCA-based kit) for MCA analysis may include,but are not limited to: PCR primers for arbitrary priming Genomic DNA;PCR buffers and nucleotides, restriction enzymes and appropriatebuffers; gene-hybridization oligos or probes; control hybridizationoligos or probes.

Additional methylation detection methods include those methods describedin, e.g., U.S. Pat. Nos. 7,553,627; 6,331,393; U.S. patent Ser. No.12/476,981; U.S. Patent Publication No. 2005/0069879; Rein, et al,26(10) NUCLEIC ACIDS RES. 2255-64 (1998); and Olek et al, 17(3) NAT.GENET. 275-6 (1997).

In another embodiment, the methylation status of selected CpG sites isdetermined using Methylation-Sensitive High Resolution Melting (HRM).Recently, Wojdacz et al. reported methylation-sensitive high resolutionmelting as a technique to assess methylation. (Wojdacz and Dobrovic,2007, Nuc. Acids Res. 35(6) e41; Wojdacz et al. 2008, Nat. Prot. 3(12)1903-1908; Balic et al, 2009 J. Mol. Diagn. 11 102-108; and US Pat. Pub.No. 2009/0155791 (Wojdacz et al)). A variety of commercially availablereal time PCR machines have HRM systems including the RocheLightCycler480, Corbett Research RotorGene6000, and the AppliedBiosystems 7500. HRM may also be combined with other amplificationtechniques such as pyrosequencing as described by Candiloro et al.(Candiloro et al, 2011, Epigenetics 6(4) 500-507).

In another embodiment, the methylation status of selected CpG locus isdetermined using a primer extension assay, including an optimized PCRamplification reaction that produces amplified targets for analysisusing mass spectrometry. The assay can also be done in multiplex. Massspectrometry is a particularly effective method for the detection ofpolynucleotides associated with the differentially methylated regulatoryelements. The presence of the polynucleotide sequence is verified bycomparing the mass of the detected signal with the expected mass of thepolynucleotide of interest. The relative signal strength, e.g., masspeak on a spectra, for a particular polynucleotide sequence indicatesthe relative population of a specific allele, thus enabling calculationof the allele ratio directly from the data. This method is described indetail in PCT Pub. No. WO 2005/012578A1 (Beaulieu et al), which ishereby incorporated by reference in its entirety. For methylationanalysis, the assay can be adopted to detect bisulfite introducedmethylation dependent C to T sequence changes. These methods areparticularly useful for performing multiplexed amplification reactionsand multiplexed primer extension reactions (e.g., multiplexedhomogeneous primer mass extension (hME) assays) in a single well tofurther increase the throughput and reduce the cost per reaction forprimer extension reactions.

Other methods for DNA methylation analysis include restriction landmarkgenomic scanning (RLGS, Costello et al, 2002, Meth. Mol Biol, 200,53-70), methylation-sensitive-representational difference analysis(MS-RDA, Ushijima and Yamashita, 2009, Methods Mol Biol 507, 1 17-130).Comprehensive high-throughput arrays for relative methylation (CHARM)techniques are described in WO 2009/021141 (Feinberg and Irizarry). TheRoche® NimbleGen® microarrays including the ChromatinImmunoprecipitation-on-chip (ChlP-chip) or methylated DNAimmunoprecipitation-on-chip (MeDIP-chip). These tools have been used fora variety of cancer applications including melanoma, liver cancer andlung cancer (Koga et al, 2009, Genome Res., 19, 1462-1470; Acevedo etal, 2008, Cancer Res., 68, 2641-2651; Rauch et al, 2008, Proc. Nat.Acad. Sci. USA, 105, 252-257). Others have reported bisulfateconversion, padlock probe hybridization, circularization, amplificationand next generation or multiplexed sequencing for high throughputdetection of methylation (Deng et al, 2009, Nat. Biotechnol 27, 353-360;Ball et al, 2009, Nat. Biotechnol 27, 361-368; U.S. Pat. No. 7,611,869(Fan)). As an alternative to bisulfate oxidation, Bayeyt et al. havereported selective oxidants that oxidize 5-methylcytosine, withoutreacting with thymidine, which are followed by PCR or pyro sequencing(WO 2009/049916 (Bayeyt et al).

In some instances, quantitative amplification methods (e.g.,quantitative PCR or quantitative linear amplification) are used toquantify the amount of intact DNA within a locus flanked byamplification primers following restriction digestion. Methods ofquantitative amplification are disclosed in, e.g., U.S. Pat. Nos.6,180,349; 6,033,854; and 5,972,602, as well as in, e.g., DeGraves, etal, 34(1) BIOTECHNIQUES 106-15 (2003); Deiman B, et al., 20(2) MOL.BIOTECHNOL. 163-79 (2002); and Gibson et al, 6 GENOME RESEARCH 995-1001(1996).

Following reaction or separation of nucleic acid in a methylationspecific manner, the nucleic acid in some cases are subjected tosequence-based analysis. For example, once it is determined that oneparticular genomic sequence from a sample is hypermethylated orhypomethylated compared to its counterpart, the amount of this genomicsequence can be determined. Subsequently, this amount can be compared toa standard control value and used to determine the present of breastcancer in the sample. In many instances, it is desirable to amplify anucleic acid sequence using any of several nucleic acid amplificationprocedures which are well known in the art. Specifically, nucleic acidamplification is the chemical or enzymatic synthesis of nucleic acidcopies which contain a sequence that is complementary to a nucleic acidsequence being amplified (template). The methods and kits may use anynucleic acid amplification or detection methods known to one skilled inthe art, such as those described in U.S. Pat. No. 5,525,462 (Takarada etal); U.S. Pat. No. 6,114,117 (Hepp et al); U.S. Pat. No. 6,127,120(Graham et al); U.S. Pat. No. 6,344,317 (Urnovitz); U.S. Pat. No.6,448,001 (Oku); U.S. Pat. No. 6,528,632 (Catanzariti et al); and PCTPub. No. WO 2005/111209 (Nakajima et al).

In some embodiments, the nucleic acids are amplified by PCRamplification using methodologies known to one skilled in the art. Oneskilled in the art will recognize, however, that amplification can beaccomplished by any known method, such as ligase chain reaction (LCR),Q-replicas amplification, rolling circle amplification, transcriptionamplification, self-sustained sequence replication, nucleic acidsequence-based amplification (NASBA), each of which provides sufficientamplification. Branched-DNA technology is also optionally used toqualitatively demonstrate the presence of a sequence of the technology,which represents a particular methylation pattern, or to quantitativelydetermine the amount of this particular genomic sequence in a sample.Nolte reviews branched-DNA signal amplification for direct quantitationof nucleic acid sequences in clinical samples (Nolte, 1998, Adv. Clin.Chem. 33:201-235).

The PCR process is well known in the art and include, for example,reverse transcription PCR, ligation mediated PCR, digital PCR (dPCR), ordroplet digital PCR (ddPCR). For a review of PCR methods and protocols,see, e.g., Innis et al, eds., PCR Protocols, A Guide to Methods andApplication, Academic Press, Inc., San Diego, Calif. 1990; U.S. Pat. No.4,683,202 (Mullis). PCR reagents and protocols are also available fromcommercial vendors, such as Roche Molecular Systems. In some instances,PCR is carried out as an automated process with a thermostable enzyme.In this process, the temperature of the reaction mixture is cycledthrough a denaturing region, a primer annealing region, and an extensionreaction region automatically. Machines specifically adapted for thispurpose are commercially available.

In some embodiments, amplified sequences are also measured usinginvasive cleavage reactions such as the Invader® technology (Zou et al,2010, Association of Clinical Chemistry (AACC) poster presentation onJul. 28, 2010, “Sensitive Quantification of Methylated Markers with aNovel Methylation Specific Technology; and U.S. Pat. No. 7,011,944(Prudent et al)).

Suitable next generation sequencing technologies are widely available.Examples include the 454 Life Sciences platform (Roche, Branford, Conn.)(Margulies et al. 2005 Nature, 437, 376-380); Illumina's GenomeAnalyzer, GoldenGate Methylation Assay, or Infinium Methylation Assays,i.e., Infinium HumanMethylation 27K BeadArray or VeraCode GoldenGatemethylation array (Illumina, San Diego, Calif.; Bibkova et al, 2006,Genome Res. 16, 383-393; U.S. Pat. Nos. 6,306,597 and 7,598,035(Macevicz); U.S. Pat. No. 7,232,656 (Balasubramanian et al.)); QX200™Droplet Digital™ PCR System from Bio-Rad; or DNA Sequencing by Ligation,SOLiD System (Applied Biosystems/Life Technologies; U.S. Pat. Nos.6,797,470, 7,083,917, 7,166,434, 7,320,865, 7,332,285, 7,364,858, and7,429,453 (Barany et al); the Helicos True Single Molecule DNAsequencing technology (Harris et al, 2008 Science, 320, 106-109; U.S.Pat. Nos. 7,037,687 and 7,645,596 (Williams et al); U.S. Pat. No.7,169,560 (Lapidus et al); U.S. Pat. No. 7,769,400 (Harris)), the singlemolecule, real-time (SMRT™) technology of Pacific Biosciences, andsequencing (Soni and Meller, 2007, Clin. Chem. 53, 1996-2001);semiconductor sequencing (Ion Torrent; Personal Genome Machine); DNAnanoball sequencing; sequencing using technology from Dover Systems(Polonator), and technologies that do not require amplification orotherwise transform native DNA prior to sequencing (e.g., PacificBiosciences and Helicos), such as nanopore-based strategies (e.g.,Oxford Nanopore, Genia Technologies, and Nabsys). These systems allowthe sequencing of many nucleic acid molecules isolated from a specimenat high orders of multiplexing in a parallel fashion. Each of theseplatforms allow sequencing of clonally expanded or non-amplified singlemolecules of nucleic acid fragments. Certain platforms involve, forexample, (i) sequencing by ligation of dye-modified probes (includingcyclic ligation and cleavage), (ii) pyrosequencing, and (iii)single-molecule sequencing.

Pyrosequencing is a nucleic acid sequencing method based on sequencingby synthesis, which relies on detection of a pyrophosphate released onnucleotide incorporation. Generally, sequencing by synthesis involvessynthesizing, one nucleotide at a time, a DNA strand complimentary tothe strand whose sequence is being sought. Study nucleic acids may beimmobilized to a solid support, hybridized with a sequencing primer,incubated with DNA polymerase, ATP sulfurylase, luciferase, apyrase,adenosine 5′ phosphsulfate and luciferin. Nucleotide solutions aresequentially added and removed. Correct incorporation of a nucleotidereleases a pyrophosphate, which interacts with ATP sulfurylase andproduces ATP in the presence of adenosine 5′ phosphsulfate, fueling theluciferin reaction, which produces a chemiluminescent signal allowingsequence determination. Machines for pyrosequencing and methylationspecific reagents are available from Qiagen, Inc. (Valencia, Calif.).See also Tost and Gut, 2007, Nat. Prot. 2 2265-2275. An example of asystem that can be used by a person of ordinary skill based onpyrosequencing generally involves the following steps: ligating anadaptor nucleic acid to a study nucleic acid and hybridizing the studynucleic acid to a bead; amplifying a nucleotide sequence in the studynucleic acid in an emulsion; sorting beads using a picoliter multiwellsolid support; and sequencing amplified nucleotide sequences bypyrosequencing methodology (e.g., Nakano et al, 2003, J. Biotech. 102,117-124). Such a system can be used to exponentially amplifyamplification products generated by a process described herein, e.g., byligating a heterologous nucleic acid to the first amplification productgenerated by a process described herein.

CpG Methylation Data Analysis Methods

In certain embodiments, the methylation values measured for biomarkersof a biomarker panel are mathematically combined and the combined valueis correlated to the underlying diagnostic question. In some instances,methylated biomarker values are combined by any appropriate state of theart mathematical method. Well-known mathematical methods for correlatinga biomarker combination to a disease status employ methods likediscriminant analysis (DA) (e.g., linear-, quadratic-, regularized-DA),Discriminant Functional Analysis (DFA), Kernel Methods (e.g., SVM),Multidimensional Scaling (MDS), Nonparametric Methods (e.g.,k-Nearest-Neighbor Classifiers), PLS (Partial Least Squares), Tree-BasedMethods (e.g., Logic Regression, CART, Random Forest Methods,Boosting/Bagging Methods), Generalized Linear Models (e.g., LogisticRegression), Principal Components based Methods (e.g., SIMCA),Generalized Additive Models, Fuzzy Logic based Methods, Neural Networksand Genetic Algorithms based Methods. The skilled artisan will have noproblem in selecting an appropriate method to evaluate an epigeneticmarker or biomarker combination described herein. In one embodiment, themethod used in a correlating methylation status of an epigenetic markeror biomarker combination, e.g. to diagnose breast cancer or a breastcancer subtype, is selected from DA (e.g., Linear-, Quadratic-,Regularized Discriminant Analysis), DFA, Kernel Methods (e.g., SVM),MDS, Nonparametric Methods (e.g., k-Nearest-Neighbor Classifiers), PLS(Partial Least Squares), Tree-Based Methods (e.g., Logic Regression,CART, Random Forest Methods, Boosting Methods), or Generalized LinearModels (e.g., Logistic Regression), and Principal Components Analysis.Details relating to these statistical methods are found in the followingreferences: Ruczinski et al., 12 J. OF COMPUTATIONAL AND GRAPHICALSTATISTICS 475-511 (2003); Friedman, J. H., 84 J. OF THE AMERICANSTATISTICAL ASSOCIATION 165-75 (1989); Hastie, Trevor, Tibshirani,Robert, Friedman, Jerome, The Elements of Statistical Learning, SpringerSeries in Statistics (2001); Breiman, L., Friedman, J. H., Olshen, R.A., Stone, C. J. Classification and regression trees, California:Wadsworth (1984); Breiman, L., 45 MACHINE LEARNING 5-32 (2001); Pepe, M.S., The Statistical Evaluation of Medical Tests for Classification andPrediction, Oxford Statistical Science Series, 28 (2003); and Duda, R.O., Hart, P. E., Stork, D. O., Pattern Classification, WileyInterscience, 2nd Edition (2001).

In one embodiment, the correlated results for each methylation panel arerated by their correlation to the disease or tumor type positive state,such as for example, by p-value test or t-value test or F-test. Rated(best first, i.e. low p- or t-value) biomarkers are then subsequentlyselected and added to the methylation panel until a certain diagnosticvalue is reached. Such methods include identification of methylationpanels, or more broadly, genes that were differentially methylated amongseveral classes using, for example, a random-variance t-test (Wright G.W. and Simon R, Bioinformatics 19:2448-2455, 2003). Other methodsinclude the step of specifying a significance level to be used fordetermining the epigenetic markers that will be included in thebiomarker panel. Epigenetic markers that are differentially methylatedbetween the classes at a univariate parametric significance level lessthan the specified threshold are included in the panel. It doesn'tmatter whether the specified significance level is small enough toexclude enough false discoveries. In some problems better prediction isachieved by being more liberal about the biomarker panels used asfeatures. In some cases, the panels are biologically interpretable andclinically applicable, however, if fewer markers are included. Similarto cross-validation, biomarker selection is repeated for each trainingset created in the cross-validation process. That is for the purpose ofproviding an unbiased estimate of prediction error. The methylationpanel for use with new patient sample data is the one resulting fromapplication of the methylation selection and classifier of the “known”methylation information, or control methylation panel.

Models for utilizing methylation profile to predict the class of futuresamples can also be used. These models may be based on the CompoundCovariate Predictor (Radmacher et al. Journal of Computational Biology9:505-511, 2002), Diagonal Linear Discriminant Analysis (Dudoit et al.Journal of the American Statistical Association 97:77-87, 2002), NearestNeighbor Classification (also Dudoit et al.), and Support VectorMachines with linear kernel (Ramaswamy et al. PNAS USA 98:15149-54,2001). The models incorporated markers that were differentiallymethylated at a given significance level (e.g. 0.01, 0.05 or 0.1) asassessed by the random variance t-test (Wright G. W. and Simon R.Bioinformatics 19:2448-2455, 2003). The prediction error of each modelusing cross validation, preferably leave-one-out cross-validation (Simonet al. Journal of the National Cancer Institute 95:14-18, 2003 can beestimated. For each leave-one-out cross-validation training set, theentire model building process is repeated, including the epigeneticmarker selection process. In some instances, it is also evaluated inwhether the cross-validated error rate estimate for a model issignificantly less than one would expect from random prediction. In somecases, the class labels are randomly permuted and the entireleave-one-out cross-validation process is then repeated. Thesignificance level is the proportion of the random permutations thatgives a cross-validated error rate no greater than the cross-validatederror rate obtained with the real methylation data.

Another classification method is the greedy-pairs method described by Boand Jonassen (Genome Biology 3(4):research0017.1-0017.11, 2002). Thegreedy-pairs approach starts with ranking all markers based on theirindividual t-scores on the training set. This method attempts to selectpairs of markers that work well together to discriminate the classes.

Furthermore, a binary tree classifier for utilizing methylation profileis optionally used to predict the class of future samples. The firstnode of the tree incorporated a binary classifier that distinguished twosubsets of the total set of classes. The individual binary classifiersare based on the “Support Vector Machines” incorporating markers thatwere differentially expressed among markers at the significance level(e.g. 0.01, 0.05 or 0.1) as assessed by the random variance t-test(Wright G. W. and Simon R. Bioinformatics 19:2448-2455, 2003).Classifiers for all possible binary partitions are evaluated and thepartition selected is that for which the cross-validated predictionerror is minimum. The process is then repeated successively for the twosubsets of classes determined by the previous binary split. Theprediction error of the binary tree classifier can be estimated bycross-validating the entire tree building process. This overallcross-validation includes re-selection of the optimal partitions at eachnode and re-selection of the markers used for each cross-validatedtraining set as described by Simon et al. (Simon et al. Journal of theNational Cancer Institute 95:14-18, 2003). Several-fold cross validationin which a fraction of the samples is withheld, a binary tree developedon the remaining samples, and then class membership is predicted for thesamples withheld. This is repeated several times, each time withholdinga different percentage of the samples. The samples are randomlypartitioned into fractional test sets (Simon R and Lam A. BRB-ArrayToolsUser Guide, version 3.2. Biometric Research Branch, National CancerInstitute).

Thus, in one embodiment, the correlated results for each marker b) arerated by their correct correlation to the disease, preferably by p-valuetest. It is also possible to include a step in that the markers areselected d) in order of their rating.

In additional embodiments, factors such as the value, level, feature,characteristic, property, etc. of a transcription rate, mRNA level,translation rate, protein level, biological activity, cellularcharacteristic or property, genotype, phenotype, etc. can be utilized inaddition prior to, during, or after administering a therapy to a patientto enable further analysis of the patient's cancer status.

In some embodiments, a diagnostic test to correctly predict status ismeasured as the sensitivity of the assay, the specificity of the assayor the area under a receiver operated characteristic (“ROC”) curve. Insome instances, sensitivity is the percentage of true positives that arepredicted by a test to be positive, while specificity is the percentageof true negatives that are predicted by a test to be negative. In somecases, an ROC curve provides the sensitivity of a test as a function of1-specificity. The greater the area under the ROC curve, for example,the more accurate or powerful the predictive value of the test. Otheruseful measures of the utility of a test include positive predictivevalue and negative predictive value. Positive predictive value is thepercentage of people who test positive that are actually positive.Negative predictive value is the percentage of people who test negativethat are actually negative.

In some embodiments, one or more of the biomarkers disclosed herein showa statistical difference in different samples of at least p<0.05,p<10⁻², p<10⁻³, p<10⁻⁴ or p<10⁻⁵. Diagnostic tests that use thesebiomarkers may show an ROC of at least 0.6, at least about 0.7, at leastabout 0.8, or at least about 0.9. In some instances, the biomarkers aredifferentially methylated in different subjects with or without breastcancer. In additional instances, the biomarkers for different subtypesof breast cancer are differentially methylated. In certain embodiments,the biomarkers are measured in a patient sample using the methodsdescribed herein and compared, for example, to predefined biomarkerlevels and are used to determine whether the patient has breast cancer,which breast cancer subtype does the patient have, and/or what is theprognosis of the patient having breast cancer. In other embodiments, thecorrelation of a combination of biomarkers in a patient sample iscompared, for example, to a predefined set of biomarkers. In someembodiments, the measurement(s) is then compared with a relevantdiagnostic amount(s), cut-off(s), or multivariate model scores thatdistinguish between the presence or absence of breast cancer, betweenbreast cancer subtypes, and between a “good” or a “poor” prognosis. Asis well understood in the art, by adjusting the particular diagnosticcut-off(s) used in an assay, one can increase sensitivity or specificityof the diagnostic assay depending on the preference of thediagnostician. In some embodiments, the particular diagnostic cut-off isdetermined, for example, by measuring the amount of biomarkerhypermethylation or hypomethylation in a statistically significantnumber of samples from patients with or without breast cancer and frompatients with different breast cancer subtypes, and drawing the cut-offto suit the desired levels of specificity and sensitivity.

Kits/Article of Manufacture

In some embodiments, provided herein include kits for detecting and/orcharacterizing the methylation profile of a biomarker described herein.In some instances, the kit comprises a plurality of primers or probes todetect or measure the methylation status/levels of one or more samples.Such kits comprise, in some instances, at least one polynucleotide thathybridizes to at least one of the methylation marker sequences describedherein and at least one reagent for detection of gene methylation.Reagents for detection of methylation include, e.g., sodium bisulfate,polynucleotides designed to hybridize to sequence that is the product ofa marker sequence if the marker sequence is not methylated (e.g.,containing at least one C-U conversion), and/or a methylation-sensitiveor methylation-dependent restriction enzyme. In some cases, the kitsprovide solid supports in the form of an assay apparatus that is adaptedto use in the assay. In some instances, the kits further comprisedetectable labels, optionally linked to a polynucleotide, e.g., a probe,in the kit.

In some embodiments, the kits comprise one or more (e.g., 1, 2, 3, 4, ormore) different polynucleotides (e.g., primers and/or probes) capable ofspecifically amplifying at least a portion of a DNA region of abiomarker described herein. Optionally, one or more detectably-labeledpolypeptides capable of hybridizing to the amplified portion are alsoincluded in the kit. In some embodiments, the kits comprise sufficientprimers to amplify 2, 3, 4, 5, 6, 7, 8, 9, 10, or more different DNAregions or portions thereof, and optionally include detectably-labeledpolynucleotides capable of hybridizing to each amplified DNA region orportion thereof. The kits further can comprise a methylation-dependentor methylation sensitive restriction enzyme and/or sodium bisulfite.

In some embodiments, the kits comprise sodium bisulfite, primers andadapters (e.g., oligonucleotides that can be ligated or otherwise linkedto genomic fragments) for whole genome amplification, andpolynucleotides (e.g., detectably-labeled polynucleotides) to quantifythe presence of the converted methylated and or the convertedunmethylated sequence of at least one cytosine from a DNA region of anepigenetic marker described herein.

In some embodiments, the kits comprise methylation sensing restrictionenzymes (e.g., a methylation-dependent restriction enzyme and/or amethylation-sensitive restriction enzyme), primers and adapters forwhole genome amplification, and polynucleotides to quantify the numberof copies of at least a portion of a DNA region of an epigenetic markerdescribed herein.

In some embodiments, the kits comprise a methylation binding moiety andone or more polynucleotides to quantify the number of copies of at leasta portion of a DNA region of a marker described herein. A methylationbinding moiety refers to a molecule (e.g., a polypeptide) thatspecifically binds to methyl-cytosine.

Examples include restriction enzymes or fragments thereof that lack DNAcutting activity but retain the ability to bind methylated DNA,antibodies that specifically bind to methylated DNA, etc.).

In some embodiments, the kit includes a packaging material. As usedherein, the term “packaging material” can refer to a physical structurehousing the components of the kit. In some instances, the packagingmaterial maintains sterility of the kit components, and is made ofmaterial commonly used for such purposes (e.g., paper, corrugated fiber,glass, plastic, foil, ampules, etc.). Other materials useful in theperformance of the assays are included in the kits, including testtubes, transfer pipettes, and the like. In some cases, the kits alsoinclude written instructions for the use of one or more of thesereagents in any of the assays described herein.

In some embodiments, kits also include a buffering agent, apreservative, or a protein/nucleic acid stabilizing agent. In somecases, kits also include other components of a reaction mixture asdescribed herein. For example, kits include one or more aliquots ofthermostable DNA polymerase as described herein, and/or one or morealiquots of dNTPs. In some cases, kits also include control samples ofknown amounts of template DNA molecules harboring the individual allelesof a locus. In some embodiments, the kit includes a negative controlsample, e.g., a sample that does not contain DNA molecules harboring theindividual alleles of a locus. In some embodiments, the kit includes apositive control sample, e.g., a sample containing known amounts of oneor more of the individual alleles of a locus.

Certain Terminology

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as is commonly understood by one of skill in theart to which the claimed subject matter belongs. It is to be understoodthat the foregoing general description and the following detaileddescription are exemplary and explanatory only and are not restrictiveof any subject matter claimed. In this application, the use of thesingular includes the plural unless specifically stated otherwise. Itmust be noted that, as used in the specification and the appendedclaims, the singular forms “a,” “an” and “the” include plural referentsunless the context clearly dictates otherwise. In this application, theuse of “or” means “and/or” unless stated otherwise. Furthermore, use ofthe term “including” as well as other forms, such as “include”,“includes,” and “included,” is not limiting.

As used herein, ranges and amounts can be expressed as “about” aparticular value or range. About also includes the exact amount. Hence“about 5 μL” means “about 5 μL” and also “5 μL.” Generally, the term“about” includes an amount that would be expected to be withinexperimental error.

The section headings used herein are for organizational purposes onlyand are not to be construed as limiting the subject matter described.

As used herein, the terms “individual(s)”, “subject(s)” and “patient(s)”mean any mammal. In some embodiments, the mammal is a human. In someembodiments, the mammal is a non-human. None of the terms require or arelimited to situations characterized by the supervision (e.g. constant orintermittent) of a health care worker (e.g. a doctor, a registerednurse, a nurse practitioner, a physician's assistant, an orderly or ahospice worker).

A “site” corresponds to a single site, which in some cases is a singlebase position or a group of correlated base positions, e.g., a CpG site.A “locus” corresponds to a region that includes multiple sites. In someinstances, a locus includes one site.

EXAMPLES

These examples are provided for illustrative purposes only and not tolimit the scope of the claims provided herein.

Example 1. General Methodology

Tumor DNA Extraction

Genomic DNA extraction from pieces of freshly frozen healthy or cancertissues was performed with QIAamp DNA Mini Kit (Qiagen) according tomanufacturer's recommendations. DNA was extracted from roughly 0.5 mg oftissue. DNA was stored at −20° C. and analyzed within one week ofpreparation.

DNA Extraction from FFPE Samples

Genomic DNA from frozen FFPE samples was extracted using QIAamp DNA FFPETissue Kit with several modifications. DNA were stored at −20° C. forfurther analysis.

Bisulfite Conversion of Genomic DNA

1 μg of genomic DNA was converted to bis-DNA using EZ DNAMethylation-Lightning™ Kit (Zymo Research) according to themanufacturer's protocol. Resulting bis-DNA had a size distribution of˜200-3000 bp, with a peak around ˜500-1000 bp. The efficiency ofbisulfite conversion was >99.8% as verified by deep-sequencing ofbis-DNA and analyzing the ratio of C to T conversion of CH (non-CG)dinucleotides.

Determination of DNA Methylation Levels of the Second Validation Cohortby Deep Sequencing of Bis-DNA Captured with Molecular-Inversion(Padlock) Probes

Padlock probes were designed to capture regions containing the CpGmarkers whose methylation levels significantly differed in any of thecomparison between any cancer tissue and any normal tissue.

Probe Design and Synthesis

Padlock probes were designed using the ppDesigner software. The averagelength of the captured region was 100 bp, with the CpG marker located inthe central portion of the captured region. Linker sequence between armscontained binding sequences for amplification primers separated by avariable stretch of Cs to produced probes of equal length. A 6-bp uniquemolecular identifier (UMI) sequence in probe design was incorporated toallow for the identification of unique individual molecular captureevents and accurate scoring of DNA methylation levels. Probes weresynthesized as separate oligonucleotides using standard commercialsynthesis methods (ITD).

Bis-DNA Capture

50 ng of bisulfite-converted DNA was mixed with padlock probes in 20 μlreactions containing 1× Ampligase buffer (Epicentre). To anneal probesto DNA, 30 second denaturation at 95° C. was followed by a slow coolingto 55° C. Hybridization was left to complete for 15 hrs at 55° C. Tofill gaps between annealed arms, 5 μl of the following mixture was addedto each reaction: 2 U of PfuTurbo polymerase (Agilent), 0.5 U ofAmpligase (Epicentre) and 250 pmol of each dNTP in 1× Ampligase buffer.5 μl of exonuclease mix (20 U of Exo I and 100 U of ExoIII, both fromEpicentre) was added and single-stranded DNA degradation was carried outat 37° C. for 2 hours, followed by enzyme inactivation for 2 minutes at94° C.

Circular products of site-specific capture were amplified by PCR withconcomitant barcoding of separate samples. Amplification was carried outusing primers specific to linker DNA within padlock probes, one of whichcontained specific 6 bp barcodes. Both primers contained Illuminanext-generation sequencing adaptor sequences. PCR was done as follows:1× Phusion Flash Master Mix, 3 μl of captured DNA and 200 nM primers,using the following cycle: 10 s @ 98° C., 8× of (1 s @ 98° C., 5 s @ 58°C., 10 s @ 72° C.), 25× of (1 s @ 98° C., 15 s @ 72° C.), 60 s @ 72° C.PCR reactions were mixed and the resulting library was size selected toinclude effective captures (˜230 bp) and exclude “empty” captures (˜150bp) using Agencourt AMPure XP beads (Beckman Coulter). Libraries weresequenced using MiSeq and HiSeq2500 systems (Illumina).

Sequencing Data Analysis

Mapping of sequencing reads was done using the software toolbisReadMapper with some modifications. First, UMI were extracted fromeach sequencing read and appended to read headers within FASTQ filesusing a custom script. Reads were on-the-fly converted as if all C werenon-methylated and mapped to in-silico converted DNA strands of thehuman genome, also as if all C were non-methylated, using Bowtie2.Methylation frequencies were calculated for all CpG dinucleotidescontained within the regions captured by padlock probes by dividing thenumbers of unique reads carrying a C at the interrogated position by thetotal number of reads covering the interrogated position.

Example 2. Breast Cancer Diagnostic

Patient data was obtained from the Cancer Genome Atlas (TCGA). DNAmethylation data were obtained from the TCGA analysis of about 450,000sites generated using the Infinium 450K Methylation Array. Methylationprofiles for breast cancer tissue and normal breast tissue wereanalyzed. Four clinical covariates were used, which includes:

Age (continuous);

Gender (categorical) with two levels: Female/Male;

Race (categorical) with three levels: Asian, Black or African Americanand White. The category American Indian or Alaska Native was removed dueto insufficient number of observations;

American Join Committee on Cancer (AJCC) stage—combined into afour-level covariate: Stage I, Stage II, Stage III and Stage IV.

The data were further modified by removal of missing value in any of thefour clinical and demographic covariates to generate 790 breast cancersamples and 97 normal breast tissue samples for subsequent diagnosticanalysis.

Six additional datasets were also obtained from TCGA which includes:

colon cancer tissue: 404

colon normal tissue: 45

liver cancer tissue: 377

liver normal tissue: 50

lung cancer tissue: 839

lung normal tissue: 74

and were used during the subsequent diagnostic analysis.

For each of the eight types of sample, each dataset (or sample set) weresplit into a training set and a test set with a 2:1 ratio. Apre-screening procedure was used first to remove excessive noise on thetraining data using the ‘moderated t-statistics’ (Smyth, G. “Linearmodels and empirical bayes methods for assessing differential expressionin microarray experiments,” Statistical Applications in Genetics andMolecular Biology 3(1): 1-25 (2004)). For each set of comparison, onetype of sample was compared against all other 7 types of samples. A listof markers with significantly difference in mean among all 8 sets ofcomparisons were retained for future analysis. The Benjamini-Hochbergprocedure (Benjamini and Hochberg, “Controlling the false discoveryrate: a practical and powerful approach to multiple testing,” Journal ofthe Royal Statistical Society. Series B Methodological p 289-300, 1995)was used to control the FDR at significance level 0.05. For multinomialclassification, least absolute shrinkage and selection operator (LASSO)was used under multinomial distribution. The tuning parameter wasdetermined by the expected generalization error estimated from 10-foldcross-validation. Similar to survival analysis in Example 2, the randomsplit scheme was repeated for 10 times to stabilize the variableselection procedure. A composite panel was constructed by keepingmarkers with a high selection probability and disregard those with lowselection probability from the 10 sets of markers selected from theaforementioned procedure.

A multi-class prediction system based on (Friedman et al.,“Regularization paths for generalized linear models via coordinatedescent,” Journal of statistical software, 33(1): 1, 2010) wasconstructed to predict the group membership of samples in the test datausing the panel of markers selected. A confusion matrix and ROC curveswere also provided to evaluate sensitivity and specificity, in additionto prediction accuracy.

The hypothesis testing was two-sided with p-value 0.05 and wasconsidered to be statistically significant. The analysis was conductedin R version 3.3.2 with the following packages used: ‘glmnet’, ‘lpc’,‘CoxBoost’, ‘limma’, and ‘ROCR’.

Table 1 shows a list of markers presented in at least 7 out of 10 randomsplit. Based on 10 random split, the median prediction accuracy on testdata was 98.0% with minimum 47.7% and maximum 99.1%. In some instances,this list of markers is used for diagnostic purposes.

TABLE 1 breast “cg01327147” “cg02680086” “cg04772948” “cg04917276”“cg05395187” cancer “cg07493516” “cg08268679” “cg08549335” “cg09819083”“cg13976210” “cg14817783” “cg15412918” “cg18482112” “cg20069090”“cg24732563” Breast- “cg00886954” “cg23690893” normal

Table 2 shows the confusion matrix (or error matrix) on TCGA testdataset. The prediction is based on a list of markers presented in atleast 7 out of 10 random split.

TABLE 2 Breast-cancer Breast-normal Breast-cancer 268 4 Breast-normal 128

Example 3. Prognosis Analysis

DNA methylation data were obtained from the TCGA analysis of about27,000 sites generated using the Infinium 450K Methylation Array.Methylation profile for breast cancer tissue was analyzed. Four clinicalcovariates were used as described in Example 1.

The data were further modified by removal of 1) negative and 0 survivaltime; or 2) missing value in any of the four clinical and demographiccovariates; to generate 967 breast cancer samples with 103 events (theevent of interest was defined as death) for subsequent diagnosticanalysis.

Additional datasets were also obtained from TCGA which includes:

Colon cancer: 365 observations with 53 events;

Liver cancer: 355 observations with 98 events;

Lung adenocarcinoma (LUAD): 516 observations with 141 events;

Lung squamous cell carcinoma (LUSC): 418 observations with 150 events;

and were used during the subsequent diagnostic analysis.

For each type of cancer: breast, colon, liver, and lung (LUAD and LUSCcombined), the full dataset was split randomly into training and testsets with 2:1 ratio. A randomized lasso was used (Meinshausen andBalmann, “Stability selection,” Journal of the Royal StatisticalSociety: Series B Statistical Methodology, 72(4): 417-473, 2010), therandom split and variable selection scheme were repeated for 10 times,which provides finite sample error control and improves stability ofvariable selection. For each random split, the univariate pre-screeningprocedure was first performed on the training data to remove excessivenoise and accelerate the computational procedure (Wasserman and Roeder,“High dimensional variable selection. Annals of statistics, 37(5A):2178, 2009). For each methylation marker, a univariate Cox proportionalhazards model was fitted by using each marker as the covariate. A markerwith p-value ≤0.05 from the Wald statistic was retained in the dataset.

Four variable selection methods suitable for high-dimensionality on theprescreened training dataset were applied: Least Absolute Shrinkage andSelection Operator (LASSO) (Tibshirani, “Regression shrinkage andselection via the lasso,” Journal of the Royal Statistical Society.Series B (Methodological), p 26′7-288, 1996), Elastic Net (Zou andHastie, “Regularization and variable selection via the elastic net,”Journal of the Royal Statistical Society: Series B (StatisticalMethodology), 67(2): 301-320, 2005), Lassoed Principal Components (LPC)(Witten and Tibshirani, “Testing significance of features by lassoedprincipal components,” The annals of applied statistics, 2(3): 986,2008) and Boosting [Binder et al., “Boosting for high-dimensionaltime-to event data with competing risks,” Bioinformatics, 25(7):890-896, 2009]. For LASSO and elastic net, the tuning parameters (λ forLASSO and λ, α for elastic net) were determined according to theexpected generalization error estimated from 10-fold cross-validationand information-based criteria AIC/BIC. For LPC, the markers withp-value ≤0.05 after False Discovery Rate (FDR) correction wereconsidered to be statistically significant. For boosting, the optimalstep was determined by expected generalization error estimated from10-fold cross-validation. For all methods, the number of markers wasalso governed by the effective sample size in the training dataset,which approximately equaled to the number of events (death). A Coxproportional hazards model was fitted on the training data using markersselected at the optimal step as the covariates. The predictability ofthe model was evaluated by ρ² on the training data and concordanceprobability (also known as c-index) on the test data. ρ²—the proportionof explained randomness (O'Quigley et al., “Explained randomness inproportional hazards models,” Statistics in medicine, 24(3): 479-489,2005), is a function of Kullback-Leibler information gain boundedbetween 0 and 1, with a larger value indicating larger proportion ofrandomness explained. C-index (Harrell et al., “Tutorial inbiostatistics multivariable prognostic models: issues in developingmodels, evaluating assumptions and adequacy, and measuring and reducingerrors,” Statistics in medicine, 15: 361-387, 1996) calculates theproportions of concordant pairs among all pairs of observations with 1indicating perfect prediction accuracy. The selection of the optimaltuning parameter was difficult given the variability in samples, assuch, a composite panel was constructed by keeping markers with a highselection probability and disregard those with low selection probabilityfrom the 10 sets of markers selected from the aforementioned procedure.

To validate, a Cox proportional hazards model was fitted using the panelof markers with high selection probability on the training data. Bymultiplying the coefficient estimates and the design matrix in the testdata, a risk score was obtained for each observation in the test data.By dividing the risk score according to its median, a high risk groupand a low risk group were formed with roughly equal number ofobservations. A plot of Kaplan-Meier estimator and log-rank test wereincluded to determine if the median survival time was significantlydifferent. A model-based prediction was also provided. The highconcordance between the non-parametric and semi-parametric predictioncurves indicated the possibility of accurately predicting a newpatient's survival status for any future time point using the panel ofmarkers selected.

Table 3 illustrates a list of markers selected in 3 out of 10training/test split. In some instances, the list of markers is used forprognosis of a subject having breast cancer. Table 4 illustratesvalidation and prediction performance.

By using two different statistical learning algorithms, a panel of 19and 11 methylation markers present in at least 3 out of 10 “randomlysplit-screen-selection” procedure was identified (see Table 4). Amongthese markers identified, there were 10 overlapping markers. Theaverage, the proportion of explained randomness calculated from thetraining data is 0.86 (min: 0.59; max: 0.98) for LASSO and 0.90 (min:0.75; max: 0.99) for boosting, respectively. The average C-indexcalculated from the test data is 0.63 (min: 0.56; max: 0.71) for LASSOand 0.61 (min: 0.54; max: 0.68) for boosting. The values from bothcriteria indicated good predictability from the methylation signatures.The prognostic utility on TCGA data on newly generated TCGA training andtest datasets with 2:1 ratio was also evaluated. In a validation study,5 out of 10 times the panel of aggregated methylation markers from LASSOcan separate groups of high and low risk patients completely; 3 out of10 times the panel of aggregated methylation markers from boosting canseparate different risk groups.

Table 5 shows a log-rank test on the test data (Chi-squared test=14.3,df=1, p=0.0002). High and low risk group classification is based on riskscore using markers selected by the method LASSO.

Table 6 illustrates a log-rank test on the test data (Chi-squaredtest=4.5, df=1, p=0.03). High and low risk group classification is basedon risk score using markers selected by the method Boosting.

TABLE 3 LASSO “cg00819310” “cg03156547” “cg04447890” “cg06605933”“cg08623383” “cg09601629” “cg09799714” “cg10971790” “cg11851098”“cg12188860” “cg13278334” “cg15357639” “cg17188046” “cg21230435”“cg22043361” “cg23653712” “cg24229963” “cg25189085” “cg25488021”Boosting “cg00819310” “cg04447890” “cg08623383” “cg09799714”“cg10971790” “cg15357639” “cg17188046” “cg21230435” “cg22043361”“cg24229963” “cg24714666” Overlapping “cg00819310” “cg04447890”“cg08623383” “cg09799714” “cg10971790” “cg15357639” “cg17188046”“cg21230435” “cg22043361” “cg24229963

TABLE 4 LASSO ρ² on training 0.86 (min: 0.59-max: 0.98) c-index on test0.63 (min: 0.56-max: 0.71) Boosting ρ² on training 0.90 (min: 0.75-max:0.99) c-index on test 0.61 (min: 0.54-max: 0.68) log-rank 5/10 p-value <0.05 LASSO log-rank 3/10 p-value < 0.05 Boosting

TABLE 5 N Observed Expected High risk 160 24 13.5 Low risk 160 9 19.5

TABLE 6 N Observed Expected High risk 160 20 14.4 Low risk 160 8 13.6

FIG. 1 illustrates Kaplan-Meier curves from LASSO (left panel) andBosting (right panel).

FIG. 2 shows Cox proportional hazards regression prediction curves fromLASSO (left panel) and Boosting (right panel).

FIG. 3 shows a multiclass ROC curve from LASSO.

Example 4. Diagnosis of Breast Cancer or Ovarian Cancer Utilizing aCell-Free DNA Sample

Cell-free DNA sample was obtained from a QIAamp Circulating Nucleic AcidKit. Methylation profile of biomarker cp10673833 (Cob-2) was used forthe analysis.

The distribution of Cob-2 methylation rate of cell-free DNA (cfDNA) innormal and breast cancer plasma is shown in FIG. 4. The frequency ofmethylation in the cancer sample is higher relative to the frequency ofmethylation in the normal sample. Similarly, the methylation rate ofCob-2 from a subject having breast cancer is higher relative to themethylation rate of Cob-2 from a normal subject (FIG. 5). Upontreatment, the rate of methylation is observed to decrease in theabsence of tumor burden (FIG. 6). Further, the methylation rate isobserved to decrease after treatment but not prior to treatment or afterrecurrence (FIG. 6). The accuracy of using Cob-2 was assessed by the ROCcurve (FIG. 7) with AUC of 0.9531. The methylation rate of Cob-2 indifferent subpopulations are shown in FIG. 8 (partial response group),FIG. 9 (stable disease group), FIG. 10 (progressive disease group) andFIG. 11 (post-surgery group).

FIG. 12 show boxplots for the methylation changes in four differentresponse groups. ANOVA (F-test=29.748, p-value <0.001) (Table 7)indicates the mean methylation change is different across four groups.By using Tukey's post-hoc analysis (Table 8), a pairwise comparison wasconducted between all possible combinations. In addition, the CR and PRgroups were combined as the response group, and repeated theaforementioned analysis (FIG. 13). ANOVA (F-test=29.764, p-value <0.001)(Table 9) indicates the mean methylation change is significantlydifferent across three groups. By using Tukey's post-hoc analysis (Table10), the methylation changes between all pairwise comparisons aredifferent.

FIG. 14 shows methylation rate of Cob-2 from a subject having ovariancancer relative to the methylation rate of Cob-2 from a normal subject.Upon treatment, the rate of methylation is observed to decrease in theabsence of tumor burden (FIG. 14A). FIG. 14B shows a boxplot of themethylation changes in the different response group.

TABLE 7 Summary statistics mean (standard deviation) and ANOVA resultsfor breast cancer surgery (n = 36) PR (n = 20) SD (n =13) PD (n = 10)F-statistics p-value Δ cfDNA −0.10 (0.18) −0.28 (0.14) −0.02 (0.04) 0.26(0.14) 29.748 <.001***

TABLE 8 Tukey's post-hoc analysis on pairwise comparison for breastcancer adjust mean.diff lower 95% CI upper 95% CI p-value PR-surgery−0.17 −0.28 −0.06 0.00 SD-surgery 0.09 −0.04 0.21 0.28 PD-surgery 0.360.22 0.50 0.00 SD − PR 0.26 0.12 0.40 0.00 PD − PR 0.53 0.38 0.68 0.00PD − SD 0.27 0.11 0.44 0.00

TABLE 9 Summary statistics mean (standard deviation) and ANOVA resultsfor breast cancer Response (n = 56) SD (n = 13) PD (n = 10) F-statisticsp-value Δ −0.17 −0.02 (0.04) 0.26 (0.14) 29.764 <.001*** cfDNA (0.18)

TABLE 10 Tukey's post-hoc analysis on pairwise comparison for breastcancer adjust mean.diff lower 95% CI upper 95% CI p-value SD-Response0.15 0.03 0.27 0.01 PD-Response 0.42 0.29 0.56 0.00 PD − SD 0.27 0.110.44 0.00

Example 5. Identification of Methylation Correlated Block (MCB)

In some instances, closely positioned CpG have similar methylationlevels, due to a processivity and lack of sequence-specificity of DNAmethyltransferases and demethylases, as well as the concept of haplotypeblocks in genetic linkage analysis. Pearson correlation coefficients r2between β values of any two CpGs positioned within one kilobase of oneanother were calculated. A cutoff of r2>0.5 was used to identifyMethylation Correlated Block (MCB) (also refers to herein as BCM) withinregions interrogated by the padlock probes. A value of Pearson's r<0.5was used to identify transition spots (boundaries) between any twoadjacent markers indicating uncorrelated methylation. Markers notseparated by a boundary were combined into Methylation Correlated Block(MCB). This procedure combined between 2 and 22 CpG positions in eachblock to identify a total number of BCMs in each diagnostic categorywithin the padlock data. Methylation frequencies for entire MCBs werecalculated by summing up the numbers of Cs at all interrogated CpGpositions within a BCM and dividing by the total number of C+Ts at thosepositions Pearson correlation coefficients between methylationfrequencies of each pair of CpG markers separated by no more than 200 bpwere calculated separately from 30 cancer and 30 corresponding normaltissue samples from each of the two diagnostic categories. A value ofPearson's r<0.5 was used to identify transition spots (boundaries)between any two adjacent markers indicating uncorrelated methylation.Markers not separated by a boundary were combined into MethylationCorrelated Block (MCB). Methylation frequencies for entire BCMs werecalculated by summing up the numbers of Cs at all interrogated CpGpositions within a BCM and dividing by the total number of C+Ts at thosepositions.

FIG. 15 illustrates an exemplary BCM for breast cancer. Data wascompiled from both healthy tissue samples and corresponding cancers, RowI represents a CG dinucleotide analyzed in this study. Subset of thosecorrespond to CG markers included on Illumina's InfiniumHumanMethylation450 BeadChip (leftmost column), whereas the majorityrepresent previously unknown potential novel markers. Row II listsgenomic distances between markers and Row III shows genomic location ofeach analyzed CG. Each row within Row I illustrates Pearson correlationcoefficients r2 between β values of two closely positioned CGscalculated for samples from each tissue type separately. Correlationbetween any two markers is represented by a gray square at theintersection of (virtual) perpendicular lines originating from these twomarkers. White color indicates no significant correlation, gray colorintensity marks r2 values between 0.5 and 1, Black boxes indicate theends of analyzed regions.

Example 6. Linking Differentially Methylated Markers to Gene Expression

TCGA DNA methylation and RNAseq expression data for breast cancersamples are obtained from the TCGA website. The degree of DNAmethylation at each CpG is denoted as a beta value and is calculated as(M/(M+U)), where M and U are normalized values representing themethylated and unmethylated allele intensities respectively. Beta valuesrange from 0 to 1 and reflect the fraction of methylated alleles at eachCpG in each sample. The methylation beta value is calculated for all485,000 markers for each of the breast tumor and matched normal breasttissues in the TCGA data. CpG markers with a mean value less than 0.05or greater than 0.95 are selected for further evaluation. Markers with adifference between the mean methylation value for the tumor tissue andthe mean methylation value of the corresponding normal tissue of greaterthan 0.5 are also selected. At the intersection of these two groups,markers for which the mean methylation is <0.05 for normal breast tissuesamples and the difference between normal and tumor is greater than 0.5are further selected and the genes associated with these markers areidentified. For each marker, the tumor samples are then separated intothose with methylation values greater than the mean value of the tumorsamples and those with methylation values less than the mean value ofthe tumor samples. Next, the RNAseq data in the TCGA data is examinedand the relative expression of each gene is calculated. Because of thewide variation of the expression values, the values are adjusted asfollows: log 2 (expressionValue+1). Genes are identified in which thedifference in the methylation values correlated with variation in theassociated gene expression levels. Genes for which there is acorrelation were selected for further functional evaluation andvalidation.

DNA/RNA Isolation and Quantitative PCR

Tumor and corresponding far site samples of the same tissue are obtainedfrom patients who underwent surgical tumor resection; samples are frozenand preserved at −80° C. until use. Isolation of DNA and RNA fromsamples is performed using AllPrep DNA/RNA Mini kit (Qiagen, Valencia,Calif.) according to the manufacturer's recommendations. During RNAisolation, the sample is subjected to on-column DNase digestion. RNA isquantified using a Nanodrop 2000 (Thermo Scientific). 200 ng RNA of eachsample is used for cDNA synthesis using iScript cDNA synthesis kit(Bio-rad, Inc) according to the manufacturer's instructions. qPCR isperformed by a standard 40-cycle amplification protocol usinggene-specific primers and a Power SYBR Green PCR Master Mix on a 7500Real Time PCR system (Applied Biosystems). Experiments are carried outin triplicate and normalized to endogenous ACTB levels. Relative foldchange in expression is calculated using the AACT method (cyclethreshold values <30).

Cell Culture and Gene Transfections

Human breast cancer cell line MDA-MB-231 and the human embryonic kidneycell line HEK293a are obtained from American type culture collection(Manassas, Va., USA) and cultured according to their instructions. Theexpression construct for a gene disclosed herein is purchased fromOrigene in a form of TrueORF® cDNA clones in pCMV6-Entry vector. cDNAsare shuttled into pLenti-C-mGFP (Origene) to create a lentivectorencoding a fusion protein between the desired gene and mGFP.

Lentiviral particles are made by co-transfection of HEK-293T cells witha breast cancer gene mGFP lentivector together with a third-generationpackaging vector using calcium phosphate precipitation. Viralsupernatants are collected 36 hours post-transfection. Human breastcancer cell line MDA-DB-231 are plated in a 6-well plate the day beforetransfection of the breast cancer gene mGFP lentivector. Stable celllines are generated by infecting cells with viral particles at the MOIof ˜5 for 24 hrs and are collected and sorted to 100% GFP—positivityusing FACS. The GFP positive cells are then used for a colony formationassay in cell culture and tumor xenograft in nude mice.

Colony Formation Assays

Cells are plated in 6-well plates at a density of 500 cells per well andare cultured at 37° C. with 5% CO2 humidified air for 14 days. Thecolonies are fixed with 10% formaldehyde for 5 min and then stained with0.1% crystal violet for 30 seconds. Colony consisting of 50 or morecells are counted. The experiment is performed in triplicate andrepeated 3 times. Plate efficiency=(colony numbers/inoculated cellnumbers)×100%.

Tumor Xenograft

All animal studies are performed in accordance with institutional andinternational animal regulations. Animal protocols are approved by theInstitutional Animal Care and Use Committee of Sun Yat-Sen University.Female athymic BALB/c nude mice (4-5 weeks of age, 18-20 g) arepurchased from a vendor (Guangdong Province Laboratory Animal Center,Guangzhou, China).

Mice are injected subcutaneously with 100 μl of tumor cells suspended inserum free medium. Tumor growth is monitored every 3 days by visualexamination. Tumor sizes are measured using a caliper, and tumor volumeis calculated according to the following equation: tumor volume(mm3)=(length (mm)×width (mm)2)×0.5. All animals are sacrificed 3-4weeks postinjection and the xenografts were harvested. Representativedata are obtained from five mice per experimental group. Statisticalanalyses are performed with one-way repeated-measures ANOVA.

Example 7

Table 11A-Table 11B illustrate the gene names referenced by the CpGsites described herein. Table 11A illustrates the CpG sites and therespective gene names.

CpG Site Gene Name Description Alternatives cg01327147 KIAA1161Uncharacterized — family 31 glucosidase KIAA1161 cg02680086 SLC43A1solute carrier family prostate cancer overexpressed gene 1 protein; 43member 1 L-type amino acid transporter 3; POV1; LAT3; PB39; largeneutral amino acids transporter small subunit 3; prostate canceroverexpressed gene 1; and R00504 cg04772948 LOC284788 uncharacterized —LOC284788 cg04917276 HNF1B HNF1 homeobox B HNF-1-beta; VHNF1; TCF-2;hepatocyte nuclear factor 1-beta; variant hepatic nuclear factor 1;HPC11; LF-B2; MODY5; FJHN; HNF2; and LFB3 cg05395187 NCOR2 nuclearreceptor T3 receptor-associating factor; CTG repeat corepressor 2protein 26; SMAP270; N-CoR2; CTG26; SMRT; TRAC; silencing mediator ofretinoic acid and thyroid hormone receptor; SMRTE- Tau; TNRC14; andSMRTE cg07493516 — — — cg08268679 — — — cg08549335 ZNRF2 zinc and ringfinger 2, zinc and ring finger 2; RING finger protein E3 ubiquitinprotein 202; Protien Elis2; RNF202; and E3 ligase ubiquitin-proteinligase ZNRF2 cg09819083 — — — cg13976210 DUSP12 dual specificityserine/threonine specific protein phsphatase; phosphatase 12 dualspecificity tyrosine phosphatase YVH1; and DUSP1 cg14817783 KLHL23 Kelchlike family DITHP member 23 cg15412918 — — — cg18482112 — — — cg20069090POLR1D RNA polymerase DNA-directed RNA polymerase 1 subunit D; subunit DRPA16; RPC16; AC19; DNA-directed RNA polymerase I and III subunit RPAC2;POLR1C; RPO1-3; HRPA19; RPAC2; RPA9; and TCS2 cg24732563 — — —cg00886954 PLEC1 plectin PLTN; HD1; PCN; LGMD2Q; PLEC1b; EBSMD; EBSND;EBSOG; EBSPA; EBSO; and EBS1 cg23690893 TECR trans-2,3-enoyl-CoAsynaptic glycoprotein SC2; GPSN2; TER; reductase very-long-chainenoyl-CoA reductase; and MRT14 cg10673833 MYO1G myosin IG minorhistocompatibility antigen HA-2; unconventional myosin-Ig; HLA-HA2; andMHAG cg00819310 VANGL1 VANGL planar cell loop-tail protein 2 homolog;Van Gogh-like polarity protein 1 protein 1; Strabismus 2; LPP2; STB2;KAI1 C-terminal interacting tetraspanin; Van-Like protein 1; KITENIN;and STBM2 cg04447890 GPR177 G protein-coupled Wntless receptor 177cg08623383 C1orf38 chromosome 1 open — reading frame 38 cg09799714 PDZD3PDZ domain natrium-phosphate cotransporter IIa C- containing 3terminal-associated protein 2; Na/Pi cotransporter C-terminal-associatedprotein 2; sodium-hydrogen exchanger regulatory factor 4; intestinal andkidney enriched PDZ protein; NHERF-4; PDZK2; and IKEPP cg10971790 FUZfuzzy planar cell protien fuzzy homolog and NTD polarity proteincg15357639 OGG1 8-oxoguanine DNA 8-hydroxyguanine DNA glycosylase;glycosylase MUTM; OGH1; DNA-apurinic or apyrimidinic site lyase;N-glycosylase/DNA lyase; OGG1 type 1e; OGG1 type 1d; AP lyase; HMMH; andMMH cg17188046 T T brachyury protein T; SAVA; TFT transcription factorcg21230435 OPN1SW opsin 1 (cone blue cone photoreceptor pigment; blue-pigments), short-wave- sensitive opsin; BOP; BCP; short-wave- sensitivesensitive opsin 1; and CBT cg22043361 ZBTB25 zinc finger and BTB zincfinger and BTB domain-containing domain containing 25 protein 25; zincfinger protein KUP; zinc finger protein 46; KUP; ZNF46 cg24229963 ZFAND1zinc finger, AN1-type zinc finger, AN1-type domain 1 containing 1cg24714666 — — — cg03156547 CDH24 cadherin 24 CDH11L cg06605933 BOLA1BolA family member 1 BolA-like protein 1; BolA homolog 1; CGI- 143; andHBolA cg09601629 CCDC15 coiled-coil domain — containing 15 cg13278334PIH1D1 PIH1 domain Nucleolar protein 17 homolog; NOP17 containing 1cg11851098 WBP2NL WBP2 N-terminal like postacrosomal sheath WWdomain-binding protein; WW domain-binding protein 2-like; PAWP; andGRAMD7 cg12188860 TOP1MT topoisomerase (DNA) — I, mitochondrialcg25189085 STAC3 SH3 and cysteine rich — domain 3 cg25488021 EPB41L2erythrocyte membrane generally expressed protein 4.1 protein band 4.1like 2 cg10673833.1 MYO1G myosin IG minor histocompatibility antigenHA-2; unconventional myosin-Ig; HLA-HA2; and MHAG

Table 11B shows the associated chromosome location with the CpG sitesdescribed herein.

CpG Site Genome_Build CHR MAP INFO Chromosome_36 Coordinate_36 Gene Namecg01327147 37 9 34371380 9 34361380 KIAA1161 cg02680086 37 11 5726724411 57023820 SLC43A1 cg04772948 37 20 22401407 20 22349407 LOC284788cg04917276 37 17 36104585 17 33178698 HNF1B cg05395187 37 12 1.25E+08 12123479670 NCOR2 cg07493516 37 4 54957554 4 54652311 — cg08268679 37 12.35E+08 1 233220910 — cg08549335 37 7 30387954 7 30354479 ZNRF2cg09819083 37 1 1.11E+08 1 110474702 — cg13976210 37 1 1.62E+08 1159985683 DUSP12 cg14817783 37 2 1.71E+08 2 170259991 KLHL23 cg1541291837 5 1.73E+08 5 173228664 — cg18482112 37 3 1.84E+08 3 185691799 —cg20069090 37 13 28240007 13 27138007 POLR1D cg24732563 37 1 2.04E+08 1202616510 — cg00886954 37 8 1.45E+08 8 145119701 PLEC1 cg23690893 37 1914671371 19 14532371 TECR cg10673833 37 7 45018849 7 44985374 MYO1Gcg00819310 37 1 1.16E+08 1 115995306 VANGL1 cg04447890 37 1 68697988 168470576 GPR177 cg08623383 37 1 28205926 1 28078513 C1orf38 cg0979971437 11 1.19E+08 11 118561920 PDZD3 cg10971790 37 19 50316458 19 55008270FUZ cg15357639 37 3 9790443 3 9765443 OGG1 cg17188046 37 6 1.67E+08 6166502187 T cg21230435 37 7 1.28E+08 7 128203259 OPN1SW cg22043361 37 1464970199 14 64039952 ZBTB25 cg24229963 37 8 82633648 8 82796203 ZFAND1cg24714666 37 X 13752442 X 13662363 — cg03156547 37 14 23525003 1422594843 CDH24 cg06605933 37 1  1.5E+08 1 148137601 BOLA1 cg09601629 3719 15122224 19 14983224 CCDC15 cg13278334 37 19 49954994 19 54646806PIH1D1 cg11851098 37 22 42395340 22 40725286 WBP2NL cg12188860 37 81.44E+08 8 144487860 TOP1MT cg25189085 37 12 57644658 12 55930925 STAC3cg25488021 37 6 1.31E+08 6 131319140 EPB41L2 cg10673833.1 37 7 450188497 44985374 MYO1G

Example 8

Table 12 illustrates CpG sequences described herein.

SEQ ID CpG Site Gene Probe Sequence NO: cg01327147 KIAA1161TCAACATACTAAACTACCCATTCATCCTCTGTCTC  1TTATACACATCTCCGAGCCCACGAGACCCCCCCCC CCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNATCACAAAACATCTCCTACTTCTT cg02680086 SLC43A1CCTCCTATAATCTCCAACCAATAACAAAATCCTGT  2CTCTTATACACATCTCCGAGCCCACGAGACCCCCC TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTAACCCAAAACCCTAAATCCCTTCTCT cg04772948 LOC284788ACCCTCCTACAAACCTTCCACTCCACTGTCTCTTA  3TACACATCTCCGAGCCCACGAGACCCCCCCCCCCC CCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNATATTTACCCTAACCACAATTAATAT cg04917276 HNF1BCCTACAACTCCTTAAAAATAAAACTGTCTCTTATA  4CACATCTCCGAGCCCACGAGACCCCCCCCCCCCCC CCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAATAAATCCCCTCCACCT cg05395187 NCOR2ACCCTCCTAACTAAAACAAAACTGTCTCTTATACA  5CATCTCCGAGCCCACGAGACCCCCCCCCCCCCCCC CCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNCCAAAACCTAACAAAATAAAAA cg07493516 —ACCCCTAAAACCCCCTGTCTCTTATACACATCTCC  6GAGCCCACGAGACCCCCCCCCCCCCCCCCCCCCCT CGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAACTAAAAATATACACAAAATAAATA cg08268679 —ACTTCCCCAACAATTTACAAATCAAAATCTGTCTC  7TTATACACATCTCCGAGCCCACGAGACCCCCCCCC CCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTAATTACAAAAACCCAAAAA cg08533549 ZNRF2ACACTATACTACATACTAAAATAAACTAAATCCTG  8TCTCTTATACACATCTCCGAGCCCACGAGACCCCC CCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTACTTAATATTTTCCTTAATCTT cg09819083 —ACCTAACTCCCCCTACTACTCCTACTCTACCCTGT  9CTCTTATACACATCTCCGAGCCCACGAGACCCCCC CCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTCCCTCATTTTAAACCTTAAAACA cg13976210 DUSP12ACATCAACAAAAATTCACACCCCACTGTCTCTTAT 10ACACATCTCCGAGCCCACGAGACCCCCCCCCCCCT CGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTACTTAATTAAAATTAATTTCTTATAAT cg14817783 KLHL23AAATCTTTTTATTCTTTCATTTTAAAAACTGTCTC 11TTATACACATCTCCGAGCCCACGAGACCCCCCCCT CGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTTTCTTAATTATTCCATACTTACCAACA cg15412918 —ATCTTACCTATTCTACACTACAACCTGTCTCTTAT 12ACACATCTCCGAGCCCACGAGACCCCCCCCCCCTC GTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTAATTCCTCAAATAAAACTTCAATTTTAA cg18482112 —ATAAAACCTCAACCCCACTACCTGTCTCTTATACA 13CATCTCCGAGCCCACGAGACCCCCCCCCCCCCCCC CCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTCCTAAAACTACTACTATCCTCAAAA cg20069090 POLR1DAAACAACCAAAACAAATACCTGTCTCTTATACACA 14TCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCCC CCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAACACAAAAACCATCCTT cg24732563 —ACCTAAAATTCCTAAAAACATTTACCCTGTCTCTT 15ATACACATCTCCGAGCCCACGAGACCCCCCCCCCC TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAATAACATATATTTAAAAACATATATT cg00886954 PLEC1CACCCAAAATACCCCACCTGTCTCTTATACACATC 16TCCGAGCCCACGAGACCCCCCCCCCCCCCCCCCCC CCCCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAACCTCCAACACCC cg23690893 TECRTTAAACCCCACCAAAAACTGTCTCTTATACACATC 17TCCGAGCCCACGAGACCCCCCCCCCCCCCCCCCCT CGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAATTACTAAACTCCTCCAAACCACAA cg10673833 MYO1GAACACAACCTCCTTATAAAACCTGTCTCTTATACA 18CATCTCCGAGCCCACGAGACTCGTCGGCAGCGTCA GATGTGTATAAGAGACAGNNNNNNAACIAAAAACCCTCCAAA cg00819310 VANGL1 ACTCCACCCATACAACAACCACTGTCTCTTATACA 19CATCTCCGAGCCCACGAGACCCCCCCCCCCCCCCC CCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAATAAATAACAAAACCACACCT cg04447890 GPR177CCCTCCTCTCACACACTCCCCTGTCTCTTATACAC 20ATCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCC CCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNCACAACTTCTTAATACTCA cg08623383 C1orf38ACCCTATATCCCTCAACCCTACAACCCAAACTGTC TCTTATACACATCTCCGAGCCCACGAGACCCCCCC21 CCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAG NNNNNNATATATCCCTCTTCCATTCTCTATATcg09799714 PDZD3 ATTATTTCCTCCCCTTACCCCACTGTCTCTTATAC 22ACATCTCCGAGCCCACGAGACCCCCCCCCCCCCCC CCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAATACAAACTAACAACTAAACTT cg10971790 FUZCCATACTCCAAAACCCCTGTCTCTTATACACATCT 23CCGAGCCCACGAGACCCCCCCCCCCCCCCCCCCCC CCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAATTAATCCTCTTCCAATCAA cg15357639 OGG1ACTCTTCAAAAATTTACAATCTAAACCTGTCTCTT 24ATACACATCTCCGAGCCCACGAGACCCCCCCCCCC TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTAATAACACTAATCTAATATTAATTCCA cg17188046 TACAACAAATCCTATTTTTATAAAAACTGTCTCTTA 25TACACATCTCCGAGCCCACGAGACCCCCCCCCCCC CCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNACCTTCTCCCACCTTCC cg21230435 OPN1SWTTAATATTAATCATTCACAAAACCTGTCTCTTATA 26CACATCTCCGAGCCCACGAGACCCCCCCCCCCCCC CCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNCCCAATCTCTTATCCTC cg22043361 ZBTB25ACCCAAAACCACCCTTTACTCTGTCTCTTATACAC 27ATCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCC CCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAATATCAAACAAAACACA cg24229963 ZFAND1CCCCACCTATAAACTCCCTGTCTCTTATACACATC 28TCCGAGCCCACGAGACCCCCCCCCCCCCCCCCCCC CTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAACACTCACAAAACAATAACCTTT cg24714666 —CACTAAATCATTCAACTAACCCAAAATTTCTTCTG 29TCTCTTATACACATCTCCGAGCCCACGAGACCCCC CCCCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAACCTACCAACCCTC cg03156547 CDH24CCCCTAACCCTCCTCCCCCCTGTCTCTTATACACA 30TCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCCC CCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNACTAAAACTAAACCAAACC cg06605933 BOLA1ACTTTCTAACCACCTTACCAATAAAACTGTCTCTT 31ATACACATCTCCGAGCCCACGAGACCCCCCCCCCC TCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTACAAAATCTATTAACAATAAAATAAAT cg09601629 CCDC15ACCCCAACCTAACTACAAAAACTACTGTCTCTTAT 32ACACATCTCCGAGCCCACGAGACCCCCCCCCCCCC CCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAAAAATCTACTTATTAACCAACAAAA cg13278334 PIH1D1TAAAAACCAAAACAAACACCTGTCTCTTATACACA 33TCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCCC CCCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNAACACATATTCCCCAC cg11851098 WBP2NLACACCCAATACCTATCCTCATCCACTGTCTCTTAT 34ACACATCTCCGAGCCCACGAGACCCCCCCCCCCCC CCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNATTTAAAATCTTTCCAAAATAATCCA cg12188860 TOP1MTACATCACCAAACACAAACCCTGTCTCTTATACACA 35TCTCCGAGCCCACGAGACCCCCCCCCCCCCCCCCC CCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTTACTATACATAATCTTCTAAAAC cg25189085 STAC3TAAATTATAAATCAAAACAACTAAACTGTCTCTTA 36TACACATCTCCGAGCCCACGAGACCCCCCCCCCCC CCCCCCCCCCCCCCTCGTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNCCCCACCCCCACCC cg25488021 EPB41L2ACTTTAACTTTCAACTACAAAAACTGTCTCTTATA 37CACATCTCCGAGCCCACGAGACCCCCCCCCCCCTC GTCGGCAGCGTCAGATGTGTATAAGAGACAGNNNNNNTAAAATATATAACTTTTACTTCTTAAACCA

Embodiment 1 refers to a method of generating a methylation profile of abiomarker in a subject in need thereof, comprising: (a) processing anextracted genomic DNA with a deaminating agent to generate a genomic DNAsample comprising deaminated nucleotides, wherein the extracted genomicDNA is obtained from a biological sample from the subject; (b) detectinga hybridization between the extracted genomic DNA and a probe, whereinthe probe hybridizes to a biomarker selected from cg01327147(uncharacterized family 31 glucosidase KIAA1161), cg02680086 (solutecarrier family 43 member 1), cg04772948 (uncharacterized LOC284788),cg04917276 (HNF1 homeobox B), cg05395187 (nuclear receptor corepressor2), cg07493516, cg08268679, cg08549335 (zinc and ring finger 2, E3ubiquitin protein ligase), cg09819083, cg13976210 (dual specificityphosphatase 12), cg14817783 (Kelch like family member 23), cg15412918,cg18482112, cg20069090 (RNA polymerase subunit D), cg24732563,cg00886954 (plectin), cg23690893 (trans-2,3-enoyl-CoA reductase), andcg10673833 (myosin IG); and (c) generating a methylation profile basedon the detected hybridization between the extracted genomic DNA and theprobe.

Embodiment 2

The method of embodiment 1, wherein the methylation profile comprisescg10673833.

Embodiment 3

The method of embodiment 1, wherein the methylation profile comprisesone or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, and cg23690893.

Embodiment 4

The method of embodiment 1, wherein the methylation profile comprisescg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, and cg23690893.

Embodiment 5

The method of embodiment 1, wherein the probe comprises a structure ofFormula I:

wherein:

-   -   A is a first target-binding region;    -   B is a second target-binding region; and    -   L is a linker region;    -   wherein A comprises at least 70%, 80%, 90%, 95%, or 99% sequence        identity to at least 30 contiguous nucleotides starting at        position 1 from the 5′ terminus of a sequence selected from SEQ        ID NOs: 1-37; B comprises at least 70%, 80%, 90%, 95%, or 99%        sequence identity to at least 12 contiguous nucleotides starting        at position 1′ from the 3′ terminus of the same sequence        selected from SEQ ID NOs: 1-37; and    -   wherein L is attached to A; and B is attached to either A or L.

Embodiment 6

The method of embodiment 5, wherein the probe comprises a structure ofFormula Ia:

Embodiment 7

The method of embodiment 5, wherein A comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 40 contiguous nucleotidesstarting at position 1 from the 5′ terminus of a sequence selected fromSEQ ID NOs: 1-37.

Embodiment 8

The method of embodiment 5, wherein A comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 50 contiguous nucleotidesstarting at position 1 from the 5′ terminus of a sequence selected fromSEQ ID NOs: 1-37.

Embodiment 9

The method of embodiment 5, wherein B comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 15 contiguous nucleotidesstarting at position 1′ from the 3′ terminus of the same sequenceselected from SEQ ID NOs: 1-37.

Embodiment 10

The method of embodiment 5, wherein B comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 20 contiguous nucleotidesstarting at position 1′ from the 3′ terminus of the same sequenceselected from SEQ ID NOs: 1-37.

Embodiment 11

The method of embodiment 5, wherein L is about 15, 20, 25, 30, 35, 40,45, 50, 55, or 60 nucleotides in length.

Embodiment 12

The method of embodiment 1, wherein the probe comprises at least 80%,85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% sequenceidentity to a sequence selected from SEQ ID NOs: 1-37.

Embodiment 13

The method of embodiment 1, wherein the generating further comprisesgenerating a pair-wise methylation difference dataset comprising: (i) afirst difference between the methylation profile of the treated genomicDNA with a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

Embodiment 14

The method of embodiment 13, wherein the generating further comprisesanalyzing the pair-wise methylation difference dataset with a control bya machine learning method to generate the methylation profile.

Embodiment 15

The method of embodiment 13, wherein the first primary cancer sample isa breast cancer sample.

Embodiment 16

The method of embodiment 13, wherein the second primary cancer sample isa non-breast cancer sample.

Embodiment 17

The method of embodiment 14, wherein the control comprises a set ofmethylation profiles, wherein each said methylation profile is generatedfrom a biological sample obtained from a known cancer type.

Embodiment 18

The method of embodiment 17, wherein the known cancer type is breastcancer.

Embodiment 19

The method of embodiment 17, wherein the known cancer type is a relapsedor refractory breast cancer.

Embodiment 20

The method of embodiment 17, wherein the known cancer type is ametastatic breast cancer.

Embodiment 21

The method of embodiment 17, where the known cancer type is ductalcarcinoma in situ, invasive or infiltrating ductal carcinoma, invasiveor infiltrating lobular carcinoma, lobular carcinoma in situ,inflammatory breast cancer, Paget disease of the nipple, Phyllodestumor, angiosarcoma, metaplastic carcinoma, low-grade adenosquamouscarcinoma, spindle cell carcinoma of the breast, squamous carcinoma,triple-negative breast cancer, or mixed carcinoma.

Embodiment 22

The method of embodiment 21, where invasive ductal carcinoma comprisestubular carcinoma of the breast, medullary carcinoma of the breast,mucinous (or colloid) carcinoma of the breast, papillary carcinoma ofthe breast, micropapillary carcinoma, or cribriform carcinoma of thebreast.

Embodiment 23

The method of embodiment 14, wherein the machine learning methodutilizes an algorithm selected from one or more of the following: aprincipal component analysis, a logistic regression analysis, a nearestneighbor analysis, a support vector machine, and a neural network model.

Embodiment 24

The method of embodiment 1, wherein the method further comprisesperforming a DNA sequencing reaction to quantify the methylation of eachof the one or more biomarkers prior to generating the methylationprofile.

Embodiment 25 refers to a method of selecting a subject suspected ofhaving breast cancer for treatment, the method comprising: (a)processing an extracted genomic DNA with a deaminating agent to generatea genomic DNA sample comprising deaminated nucleotides, wherein theextracted genomic DNA is obtained from a biological sample from thesubject suspected of having breast cancer; (b) generating a methylationprofile comprising one or more biomarkers selected from: cg01327147(uncharacterized family 31 glucosidase KIAA1161), cg02680086 (solutecarrier family 43 member 1), cg04772948 (uncharacterized LOC284788),cg04917276 (HNF1 homeobox B), cg05395187 (nuclear receptor corepressor2), cg07493516, cg08268679, cg08549335 (zinc and ring finger 2, E3ubiquitin protein ligase), cg09819083, cg13976210 (dual specificityphosphatase 12), cg14817783 (Kelch like family member 23), cg15412918,cg18482112, cg20069090 (RNA polymerase subunit D), cg24732563,cg00886954 (plectin), cg23690893 (trans-2,3-enoyl-CoA reductase), andcg10673833 (myosin IG) from the extracted genomic DNA; (c) comparing themethylation profile of the one or more biomarkers with a control; (d)identifying the subject as having breast cancer if the methylationprofile correlates to the control; and (e) administering an effectiveamount of a therapeutic agent to the subject if the subject isidentified as having breast cancer.

Embodiment 26

The method of embodiment 25, wherein the methylation profile comprisescg10673833.

Embodiment 27

The method of embodiment 25, wherein the methylation profile comprisesone or more biomarkers selected from: cg01327147, cg02680086,cg04772948, cg04917276, cg05395187, cg07493516, cg08268679, cg08549335,cg09819083, cg13976210, cg14817783, cg15412918, cg18482112, cg20069090,cg24732563, cg00886954, and cg23690893.

Embodiment 28

The method of embodiment 25, wherein the methylation profile comprisescg01327147, cg02680086, cg04772948, cg04917276, cg05395187, cg07493516,cg08268679, cg08549335, cg09819083, cg13976210, cg14817783, cg15412918,cg18482112, cg20069090, cg24732563, cg00886954, and cg23690893.

Embodiment 29

The method of embodiment 25, wherein the comparing further comprisesgenerating a pair-wise methylation difference dataset comprising: (i) afirst difference between the methylation profile of the treated genomicDNA with a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

Embodiment 30

The method of embodiment 29, wherein the comparing further comprisesanalyzing the pair-wise methylation difference dataset with a control bya machine learning method to generate the methylation profile.

Embodiment 31

The method of embodiment 29, wherein the first primary cancer sample isa breast cancer sample.

Embodiment 32

The method of embodiment 29, wherein the second primary cancer sample isa non-breast cancer sample.

Embodiment 33

The method of embodiment 30, wherein the control comprises a set ofmethylation profiles, wherein each said methylation profile is generatedfrom a biological sample obtained from a known cancer type.

Embodiment 34

The method of embodiment 33, wherein the known cancer type is breastcancer.

Embodiment 35

The method of embodiment 33, wherein the known cancer type is a relapsedor refractory breast cancer.

Embodiment 36

The method of embodiment 33, wherein the known cancer type is ametastatic breast cancer.

Embodiment 37

The method of embodiment 30, wherein the machine learning methodutilizes an algorithm selected from one or more of the following: aprincipal component analysis, a logistic regression analysis, a nearestneighbor analysis, a support vector machine, and a neural network model.

Embodiment 38

The method of embodiment 25, wherein the generating further compriseshybridizing each of the one or more biomarkers with a probe, andperforming a DNA sequencing reaction to quantify the methylation of eachof the one or more biomarkers.

Embodiment 39 refers to a method of determining the prognosis of asubject having breast cancer or monitoring the progression of breastcancer in the subject, comprising: (a) processing an extracted genomicDNA with a deaminating agent to generate a genomic DNA sample comprisingdeaminated nucleotides, wherein the extracted genomic DNA is obtainedfrom a biological sample from the subject having breast cancer; (b)generating a methylation profile comprising one or more biomarkersselected from: cg00819310 (VANGL planar cell polarity protein 1),cg04447890 (G protein-coupled receptor 177), cg08623383 (chromosome 1open reading frame 38), cg09799714 (PDZ domain containing 3), cg10971790(fuzzy planar cell polarity protein), cg15357639 (8-oxoguanine DNAglycosylase), cg17188046 (T brachyury transcription factor), cg21230435(opsin 1 cone pigments, short-wave-sensitive), cg22043361 (zinc fingerand BTB domain containing 25), and cg24229963 (zinc finger AN1-typecontaining 1) from the extracted genomic DNA; (c) obtaining amethylation score based on the methylation profile of the one or morebiomarkers; and (d) based on the methylation score, initiate a firsttreatment, decrease a dosage of a first therapeutic agent if the subjecthas experienced a remission, initiate a second treatment if the subjecthas experienced a relapse, or switch to a second therapeutic agent ifthe subject becomes refractory to the first therapeutic agent.

Embodiment 40

The method of embodiment 39, wherein the methylation profile comprisescg00819310, cg04447890, cg08623383, cg09799714, cg10971790, cg15357639,cg17188046, cg21230435, cg22043361 and cg24229963.

Embodiment 41

The method of embodiment 39, wherein the methylation profile furthercomprises one or more biomarkers selected from: cg24714666, cg03156547(cadherin 24), cg06605933 (BolA family member 1), cg09601629(coiled-coil domain containing 15), cg13278334 (PIH1 domain containing1), cg11851098 (WBP2 N-terminal like), cg12188860 (topoisomerase (DNA)I, mitochondrial), cg25189085 (SH3 and cysteine rich domain 3), andcg25488021 (erythrocyte membrane protein band 4.1 like 2).

Embodiment 42

The method of embodiment 39, wherein the methylation profile furthercomprises cg24714666.

Embodiment 43

The method of embodiment 39, wherein the methylation profile furthercomprises one or more biomarkers selected from: cg03156547, cg06605933,cg09601629, cg13278334, cg11851098, cg12188860, cg25189085, andcg25488021.

Embodiment 44

The method of embodiment 39, wherein the methylation profile furthercomprises cg24714666, cg03156547, cg06605933, cg09601629, cg13278334,cg11851098, cg12188860, cg25189085, and cg25488021.

Embodiment 45

The method of embodiment 39, wherein the methylation score of from about1.5 to about 3 is indicative of a survival for at least 6 months, atleast 1 year, at least 1.5 years, at least 2 years, at least 2.5 years,at least 3 years, at least 4 years, or at least 5 years.

Embodiment 46

The method of embodiment 39, wherein the methylation score of from about1.5 to about 2.5 is indicative of a survival for at least 6 months, atleast 1 year, at least 1.5 years, at least 2 years, at least 2.5 years,at least 3 years, at least 4 years, or at least 5 years.

Embodiment 47

The method of embodiment 39, wherein the methylation score of less than1.5 is indicative of a survival of less than 5 years, less than 4 years,less than 3 years, less than 2.5 years, less than 2 years, less than 1.5years, less than 1 year, or less than 6 months.

Embodiment 48

The method of embodiment 39, wherein the methylation score is calculatedbased on Cox proportional hazards (PH) regression analysis.

Embodiment 49

The method of embodiment 39, wherein breast cancer is metastatic breastcancer.

Embodiment 50

The method of embodiment 39, wherein breast cancer is ductal carcinomain situ, invasive or infiltrating ductal carcinoma, invasive orinfiltrating lobular carcinoma, lobular carcinoma in situ, inflammatorybreast cancer, Paget disease of the nipple, Phyllodes tumor,angiosarcoma, metaplastic carcinoma, low-grade adenosquamous carcinoma,spindle cell carcinoma of the breast, squamous carcinoma,triple-negative breast cancer, or mixed carcinoma.

Embodiment 51

The method of embodiment 50, where invasive ductal carcinoma comprisestubular carcinoma of the breast, medullary carcinoma of the breast,mucinous (or colloid) carcinoma of the breast, papillary carcinoma ofthe breast, micropapillary carcinoma, or cribriform carcinoma of thebreast.

Embodiment 52

The method of embodiment 39, wherein the generating further compriseshybridizing each of the one or more biomarkers with a probe, andperforming a DNA sequencing reaction to quantify the methylation of eachof the one or more biomarkers.

Embodiment 53 refers to a method of selecting a subject suspected ofhaving ovarian cancer for treatment, the method comprising: (a)processing an extracted genomic DNA with a deaminating agent to generatea genomic DNA sample comprising deaminated nucleotides, wherein theextracted genomic DNA is obtained from a biological sample from thesubject suspected of having ovarian cancer; (b) generating a methylationprofile comprising biomarker cg10673833 (myosin IG) from the extractedgenomic DNA; (c) comparing the methylation profile of the biomarkerswith a control; (d) identifying the subject as having ovarian cancer ifthe methylation profile correlates to the control; and (e) administeringan effective amount of a therapeutic agent to the subject if the subjectis identified as having ovarian cancer.

Embodiment 54

The method of embodiment 53, wherein the comparing further comprisesgenerating a pair-wise methylation difference dataset comprising: (i) afirst difference between the methylation profile of the treated genomicDNA with a methylation profile of a first normal sample; (ii) a seconddifference between a methylation profile of a second normal sample and amethylation profile of a third normal sample; and (iii) a thirddifference between a methylation profile of a first primary cancersample and a methylation profile of a second primary cancer sample.

Embodiment 55

The method of embodiment 54, wherein the comparing further comprisesanalyzing the pair-wise methylation difference dataset with a control bya machine learning method to generate the methylation profile.

Embodiment 56

The method of embodiment 54, wherein the first primary cancer sample isan ovarian cancer sample.

Embodiment 57

The method of embodiment 54, wherein the second primary cancer sample isa non-ovarian cancer sample.

Embodiment 58

The method of embodiment 55, wherein the control comprises a set ofmethylation profiles, wherein each said methylation profile is generatedfrom a biological sample obtained from a known cancer type.

Embodiment 59

The method of embodiment 58, wherein the known cancer type is ovariancancer.

Embodiment 60

The method of embodiment 58, wherein the known cancer type is a relapsedor refractory ovarian cancer.

Embodiment 61

The method of embodiment 58, wherein the known cancer type is ametastatic ovarian cancer.

Embodiment 62

The method of embodiment 55, wherein the machine learning methodutilizes an algorithm selected from one or more of the following: aprincipal component analysis, a logistic regression analysis, a nearestneighbor analysis, a support vector machine, and a neural network model.

Embodiment 63

The method of embodiment 53, wherein the generating further compriseshybridizing each of the one or more biomarkers with a probe, andperforming a DNA sequencing reaction to quantify the methylation of eachof the one or more biomarkers.

Embodiment 64 refers to a method of generating a methylation profile ofa biomarker in a subject in need thereof, comprising: (a) processing anextracted genomic DNA with a deaminating agent to generate a genomic DNAsample comprising deaminated nucleotides, wherein the extracted genomicDNA is obtained from a biological sample from the subject; (b) detectinga hybridization between the extracted genomic DNA and a probe, whereinthe probe hybridizes to biomarker cg10673833 (myosin IG); and (c)generating a methylation profile based on the detected hybridizationbetween the extracted genomic DNA and the probe.

Embodiment 65

The method of any one of the embodiments 38, 52, or 63, wherein theprobe comprises a structure of Formula I:

wherein:

-   -   A is a first target-binding region;    -   B is a second target-binding region; and    -   L is a linker region;    -   wherein A comprises at least 70%, 80%, 90%, 95%, or 99% sequence        identity to at least 30 contiguous nucleotides starting at        position 1 from the 5′ terminus of a sequence selected from SEQ        ID NOs: 1-37; B comprises at least 70%, 80%, 90%, 95%, or 99%        sequence identity to at least 12 contiguous nucleotides starting        at position 1′ from the 3′ terminus of the same sequence        selected from SEQ ID NOs: 1-37; and    -   wherein L is attached to A; and B is attached to either A or L.

Embodiment 66

The method of embodiment 65, wherein the probe comprises a structure ofFormula Ia:

Embodiment 67

The method of embodiment 65, wherein A comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 40 contiguous nucleotidesstarting at position 1 from the 5′ terminus of a sequence selected fromSEQ ID NOs: 1-37.

Embodiment 68

The method of embodiment 65, wherein A comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 50 contiguous nucleotidesstarting at position 1 from the 5′ terminus of a sequence selected fromSEQ ID NOs: 1-37.

Embodiment 69

The method of embodiment 65, wherein B comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 15 contiguous nucleotidesstarting at position 1′ from the 3′ terminus of the same sequenceselected from SEQ ID NOs: 1-37.

Embodiment 70

The method of embodiment 65, wherein B comprises at least 70%, 80%, 90%,95%, or 99% sequence identity to at least 20 contiguous nucleotidesstarting at position 1′ from the 3′ terminus of the same sequenceselected from SEQ ID NOs: 1-37.

Embodiment 71

The method of embodiment 65, wherein L is about 15, 20, 25, 30, 35, 40,45, 50, 55, or 60 nucleotides in length.

Embodiment 72

The method of any one of the embodiments 38, 52, or 63, wherein theprobe comprises at least 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%,97%, 98%, or 99% sequence identity to a sequence selected from SEQ IDNOs: 1-37.

Embodiment 73

The method of any one of the preceding embodiments, wherein thebiological sample comprises a blood sample.

Embodiment 74

The method of any one of the preceding embodiments, wherein thebiological sample comprises a tissue biopsy sample.

Embodiment 75

The method of any one of the preceding embodiments, wherein thebiological sample comprises circulating tumor cells.

Embodiment 76

The method of any one of the preceding embodiments, wherein the subjectis a human.

Embodiment 77 refers to a kit comprising a set of nucleic acid probesthat hybridizes to biomarkers: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, cg23690893, and cg10673833.

Embodiment 78 refers to a kit comprising a set of nucleic acid probesthat hybridizes to biomarkers: cg00819310, cg04447890, cg08623383,cg09799714, cg10971790, cg15357639, cg17188046, cg21230435, cg22043361,and cg24229963.

Embodiment 79

The kit of embodiment 78, wherein the kit further comprises a nucleicacid probe that hybridizes to a biomarker selected from cg24714666,cg03156547, cg06605933, cg09601629, cg13278334, cg11851098, cg12188860,cg25189085, and cg25488021.

Embodiment 80

The kit of any one of the embodiments 77-79, wherein the set of nucleicacid probes comprises a set of probes selected from SEQ ID NOs: 1-37.

Embodiment 81 refers to a kit comprising a nucleic acid probe thathybridizes to biomarker cg10673833.

Embodiment 82

The kit of embodiment 81, wherein the nucleic acid probe comprises SEQID NO: 18.

While preferred embodiments of the present disclosure have been shownand described herein, it will be obvious to those skilled in the artthat such embodiments are provided by way of example only. Numerousvariations, changes, and substitutions will now occur to those skilledin the art without departing from the disclosure. It should beunderstood that various alternatives to the embodiments of thedisclosure described herein may be employed in practicing thedisclosure. It is intended that the following claims define the scope ofthe disclosure and that methods and structures within the scope of theseclaims and their equivalents be covered thereby.

1. A method of generating a methylation profile of a biomarker in asubject in need thereof, comprising: a) processing an extracted genomicDNA with a deaminating agent to generate a genomic DNA sample comprisingdeaminated nucleotides, wherein the extracted genomic DNA is obtainedfrom a biological sample from the subject; b) detecting a hybridizationbetween the extracted genomic DNA and a probe, wherein the probehybridizes to a biomarker selected from cg01327147 (uncharacterizedfamily 31 glucosidase KIAA1161), cg02680086 (solute carrier family 43member 1), cg04772948 (uncharacterized LOC284788), cg04917276 (HNF1homeobox B), cg05395187 (nuclear receptor corepressor 2), cg07493516,cg08268679, cg08549335 (zinc and ring finger 2, E3 ubiquitin proteinligase), cg09819083, cg13976210 (dual specificity phosphatase 12),cg14817783 (Kelch like family member 23), cg15412918, cg18482112,cg20069090 (RNA polymerase subunit D), cg24732563, cg00886954 (plectin),cg23690893 (trans-2,3-enoyl-CoA reductase), and cg10673833 (myosin IG);and c) generating a methylation profile based on the detectedhybridization between the extracted genomic DNA and the probe.
 2. Themethod of claim 1, wherein the methylation profile comprises cg10673833.3. The method of claim 1, wherein the methylation profile comprises oneor more biomarkers selected from: cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893.
 4. The method of claim 1, wherein themethylation profile comprises cg01327147, cg02680086, cg04772948,cg04917276, cg05395187, cg07493516, cg08268679, cg08549335, cg09819083,cg13976210, cg14817783, cg15412918, cg18482112, cg20069090, cg24732563,cg00886954, and cg23690893.
 5. The method of claim 1, wherein the probecomprises a structure of Formula I:

wherein: A is a first target-binding region; B is a secondtarget-binding region; and L is a linker region; wherein A comprises atleast 30 contiguous nucleotides starting at position 1 from the 5′terminus of a sequence selected from SEQ ID NOs: 1-15; B comprises atleast 12 contiguous nucleotides starting at position 1′ from the 3′terminus of the same sequence selected from SEQ ID NOs: 1-37; andwherein L is attached to A; and B is attached to either A or L.
 6. Themethod of claim 5, wherein the probe comprises a structure of FormulaIa:


7. The method of claim 5, wherein A comprises at least 40 contiguousnucleotides starting at position 1 from the 5′ terminus of a sequenceselected from SEQ ID NOs: 1-37.
 8. The method of claim 5, wherein Acomprises at least 50 contiguous nucleotides starting at position 1 fromthe 5′ terminus of a sequence selected from SEQ ID NOs: 1-37.
 9. Themethod of claim 5, wherein B comprises at least 15 contiguousnucleotides starting at position 1′ from the 3′ terminus of the samesequence selected from SEQ ID NOs: 1-37.
 10. The method of claim 5,wherein B comprises at least 20 contiguous nucleotides starting atposition 1′ from the 3′ terminus of the same sequence selected from SEQID NOs: 1-37.
 11. The method of claim 5, wherein L is about 15, 20, 25,30, 35, 40, 45, 50, 55, or 60 nucleotides in length.
 12. The method ofclaim 1, wherein the probe comprises a sequence selected from SEQ IDNOs: 1-37.
 13. The method of claim 1, wherein the generating furthercomprises generating a pair-wise methylation difference datasetcomprising: (i) a first difference between the methylation profile ofthe treated genomic DNA with a methylation profile of a first normalsample; (ii) a second difference between a methylation profile of asecond normal sample and a methylation profile of a third normal sample;and (iii) a third difference between a methylation profile of a firstprimary cancer sample and a methylation profile of a second primarycancer sample.
 14. The method of claim 13, wherein the generatingfurther comprises analyzing the pair-wise methylation difference datasetwith a control by a machine learning method to generate the methylationprofile.
 15. The method of claim 13, wherein the first primary cancersample is a breast cancer sample.
 16. The method of claim 13, whereinthe second primary cancer sample is a non-breast cancer sample.
 17. Themethod of claim 14, wherein the control comprises a set of methylationprofiles, wherein each said methylation profile is generated from abiological sample obtained from a known cancer type.
 18. The method ofclaim 17, wherein the known cancer type is breast cancer.
 19. The methodof claim 17, wherein the known cancer type is a relapsed or refractorybreast cancer.
 20. The method of claim 17, wherein the known cancer typeis a metastatic breast cancer.
 21. The method of claim 17, where theknown cancer type is ductal carcinoma in situ, invasive or infiltratingductal carcinoma, invasive or infiltrating lobular carcinoma, lobularcarcinoma in situ, inflammatory breast cancer, Paget disease of thenipple, Phyllodes tumor, angiosarcoma, metaplastic carcinoma, low-gradeadenosquamous carcinoma, spindle cell carcinoma of the breast, squamouscarcinoma, triple-negative breast cancer, or mixed carcinoma.
 22. Themethod of claim 21, where invasive ductal carcinoma comprises tubularcarcinoma of the breast, medullary carcinoma of the breast, mucinous (orcolloid) carcinoma of the breast, papillary carcinoma of the breast,micropapillary carcinoma, or cribriform carcinoma of the breast.
 23. Themethod of claim 14, wherein the machine learning method utilizes analgorithm selected from one or more of the following: a principalcomponent analysis, a logistic regression analysis, a nearest neighboranalysis, a support vector machine, and a neural network model.
 24. Themethod of claim 1, wherein the method further comprises performing a DNAsequencing reaction to quantify the methylation of each of the one ormore biomarkers prior to generating the methylation profile. 25.-27.(canceled)
 28. The method of claim 1, wherein the biological samplecomprises a blood sample.
 29. The method of claim 1, wherein thebiological sample comprises a tissue biopsy sample.
 30. The method ofclaim 1, wherein the biological sample comprises circulating tumorcells.
 31. The method of claim 1, wherein the probe comprises at least35 contiguous nucleotides starting at position 1 from the 5′ terminus ofa sequence selected from SEQ ID NOs: 1-37, or at least 14 contiguousnucleotides starting at position 1′ from the 3′ terminus of a sequenceselected from SEQ ID NOs: 1-37.